{ "hospital_name": "Methodist Hospital of Chicago dba Thorek Memorial Hospital Andersonville", "last_updated_on": "2026-02-24", "version": "3.0.0", "location_name": [ "Methodist Hospital of Chicago dba Thorek Memorial Hospital Andersonville" ], "hospital_address": [ "5025 N Paulina St, Chicago, IL 60640" ], "license_information": { "license_number": "0006155", "state": "IL" }, "type_2_npi": [ "1891755351" ], "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": "James Hartman" }, "standard_charge_information": [ { "description": "Heart transplant or implant of heart assist system with mcc", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Heart transplant or implant of heart assist system without mcc", "code_information": [ { "code": "002", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ecmo or tracheostomy with mv >96 hours or principal diagnosis excep", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Tracheostomy with mv >96 hours or principal diagnosis except face,", "code_information": [ { "code": "004", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Liver transplant with mcc or intestinal transplant", "code_information": [ { "code": "005", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Liver transplant without mcc", "code_information": [ { "code": "006", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Lung transplant", "code_information": [ { "code": "007", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Simultaneous pancreas and kidney transplant", "code_information": [ { "code": "008", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pancreas transplant", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Tracheostomy for face, mouth and neck diagnoses or laryngectomy wit", "code_information": [ { "code": "011", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Tracheostomy for face, mouth and neck diagnoses or laryngectomy wit", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Tracheostomy for face, mouth and neck diagnoses or laryngectomy wit", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Allogeneic bone marrow transplant", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Autologous bone marrow transplant with cc/mcc", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Autologous bone marrow transplant without cc/mcc", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Chimeric antigen receptor (car) t-cell and other immunotherapies", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Simultaneous pancreas and kidney transplant with hemodialysis", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intracranial vascular procedures with principal diagnosis hemorrhage", "code_information": [ { "code": "020", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intracranial vascular procedures with principal diagnosis hemorrhage", "code_information": [ { "code": "021", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intracranial vascular procedures with principal diagnosis hemorrhage", "code_information": [ { "code": "022", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Craniotomy with major device implant or acute complex cns principal", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Craniotomy with major device implant or acute complex cns principal", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Craniotomy and endovascular intracranial procedures with mcc", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Craniotomy and endovascular intracranial procedures with cc", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Craniotomy and endovascular intracranial procedures without cc/mcc", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal procedures with mcc", "code_information": [ { "code": "028", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal procedures with cc or spinal neurostimulators", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal procedures without cc/mcc", "code_information": [ { "code": "030", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ventricular shunt procedures with mcc", "code_information": [ { "code": "031", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ventricular shunt procedures with cc", "code_information": [ { "code": "032", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ventricular shunt procedures without cc/mcc", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Carotid artery stent procedures with mcc", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Carotid artery stent procedures with cc", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Carotid artery stent procedures without cc/mcc", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Extracranial procedures with mcc", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Extracranial procedures with cc", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Extracranial procedures without cc/mcc", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peripheral, cranial nerve and other nervous system procedures with", "code_information": [ { "code": "040", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peripheral, cranial nerve and other nervous system procedures with", "code_information": [ { "code": "041", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peripheral, cranial nerve and other nervous system procedures witho", "code_information": [ { "code": "042", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal disorders and injuries with cc/mcc", "code_information": [ { "code": "052", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal disorders and injuries without cc/mcc", "code_information": [ { "code": "053", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Nervous system neoplasms with mcc", "code_information": [ { "code": "054", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Nervous system neoplasms without mcc", "code_information": [ { "code": "055", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Degenerative nervous system disorders with mcc", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Degenerative nervous system disorders without mcc", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple sclerosis and cerebellar ataxia with mcc", "code_information": [ { "code": "058", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple sclerosis and cerebellar ataxia with cc", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple sclerosis and cerebellar ataxia without cc/mcc", "code_information": [ { "code": "060", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ischemic stroke, precerebral occlusion or transient ischemia with t", "code_information": [ { "code": "061", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ischemic stroke, precerebral occlusion or transient ischemia with t", "code_information": [ { "code": "062", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ischemic stroke, precerebral occlusion or transient ischemia with t", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intracranial hemorrhage or cerebral infarction with mcc", "code_information": [ { "code": "064", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intracranial hemorrhage or cerebral infarction with cc or tpa in 24", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intracranial hemorrhage or cerebral infarction without cc/mcc", "code_information": [ { "code": "066", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Precerebral occlusion without infarction with mcc", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Precerebral occlusion without infarction without mcc", "code_information": [ { "code": "068", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Transient ischemia without thrombolytic", "code_information": [ { "code": "069", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other cerebrovascular disorders with mcc", "code_information": [ { "code": "070", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other cerebrovascular disorders with cc", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other cerebrovascular disorders without cc/mcc", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cranial and peripheral nerve disorders with mcc", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cranial and peripheral nerve disorders without mcc", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Viral meningitis with cc/mcc", "code_information": [ { "code": "075", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Viral meningitis without cc/mcc", "code_information": [ { "code": "076", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hypertensive encephalopathy with mcc", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hypertensive encephalopathy with cc", "code_information": [ { "code": "078", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hypertensive encephalopathy without cc/mcc", "code_information": [ { "code": "079", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Nontraumatic stupor and coma with mcc", "code_information": [ { "code": "080", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Nontraumatic stupor and coma without mcc", "code_information": [ { "code": "081", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Traumatic stupor and coma >1 hour with mcc", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Traumatic stupor and coma >1 hour with cc", "code_information": [ { "code": "083", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Traumatic stupor and coma >1 hour without cc/mcc", "code_information": [ { "code": "084", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Traumatic stupor and coma <1 hour with mcc", "code_information": [ { "code": "085", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Traumatic stupor and coma <1 hour with cc", "code_information": [ { "code": "086", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Traumatic stupor and coma <1 hour without cc/mcc", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Concussion with mcc", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Concussion with cc", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Concussion without cc/mcc", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other disorders of nervous system with mcc", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other disorders of nervous system with cc", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other disorders of nervous system without cc/mcc", "code_information": [ { "code": "093", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bacterial and tuberculous infections of nervous system with mcc", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bacterial and tuberculous infections of nervous system with cc", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bacterial and tuberculous infections of nervous system without cc/mc", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Non-bacterial infection of nervous system except viral meningitis wi", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Non-bacterial infection of nervous system except viral meningitis wi", "code_information": [ { "code": "098", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Non-bacterial infection of nervous system except viral meningitis wi", "code_information": [ { "code": "099", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Seizures with mcc", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Seizures without mcc", "code_information": [ { "code": "101", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Headaches with mcc", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Headaches without mcc", "code_information": [ { "code": "103", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Orbital procedures with cc/mcc", "code_information": [ { "code": "113", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Orbital procedures without cc/mcc", "code_information": [ { "code": "114", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Extraocular procedures except orbit", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intraocular procedures with cc/mcc", "code_information": [ { "code": "116", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Intraocular procedures without cc/mcc", "code_information": [ { "code": "117", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute major eye infections with cc/mcc", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute major eye infections without cc/mcc", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Neurological eye disorders", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other disorders of the eye with mcc or thrombolytic agent", "code_information": [ { "code": "124", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other disorders of the eye without mcc", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Sinus and mastoid procedures with cc/mcc", "code_information": [ { "code": "135", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Sinus and mastoid procedures without cc/mcc", "code_information": [ { "code": "136", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Mouth procedures with cc/mcc", "code_information": [ { "code": "137", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Mouth procedures without cc/mcc", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Salivary gland procedures", "code_information": [ { "code": "139", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major head and neck procedures with mcc", "code_information": [ { "code": "140", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major head and neck procedures with cc", "code_information": [ { "code": "141", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major head and neck procedures without cc/mcc", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other ear, nose, mouth and throat o.r. procedures with mcc", "code_information": [ { "code": "143", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other ear, nose, mouth and throat o.r. procedures with cc", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other ear, nose, mouth and throat o.r. procedures without cc/mcc", "code_information": [ { "code": "145", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ear, nose, mouth and throat malignancy with mcc", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ear, nose, mouth and throat malignancy with cc", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ear, nose, mouth and throat malignancy without cc/mcc", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Dysequilibrium", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Epistaxis with mcc", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Epistaxis without mcc", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Otitis media and uri with mcc", "code_information": [ { "code": "152", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Otitis media and uri without mcc", "code_information": [ { "code": "153", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other ear, nose, mouth and throat diagnoses with mcc", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other ear, nose, mouth and throat diagnoses with cc", "code_information": [ { "code": "155", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other ear, nose, mouth and throat diagnoses without cc/mcc", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Dental and oral diseases with mcc", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Dental and oral diseases with cc", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Dental and oral diseases without cc/mcc", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major chest procedures with mcc", "code_information": [ { "code": "163", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major chest procedures with cc", "code_information": [ { "code": "164", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major chest procedures without cc/mcc", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other respiratory system o.r. procedures with mcc", "code_information": [ { "code": "166", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other respiratory system o.r. procedures with cc", "code_information": [ { "code": "167", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other respiratory system o.r. procedures without cc/mcc", "code_information": [ { "code": "168", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ultrasound accelerated and other thrombolysis with principal diagnos", "code_information": [ { "code": "173", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pulmonary embolism with mcc or acute cor pulmonale", "code_information": [ { "code": "175", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pulmonary embolism without mcc", "code_information": [ { "code": "176", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory infections and inflammations with mcc", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory infections and inflammations with cc", "code_information": [ { "code": "178", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory infections and inflammations without cc/mcc", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory neoplasms with mcc", "code_information": [ { "code": "180", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory neoplasms with cc", "code_information": [ { "code": "181", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory neoplasms without cc/mcc", "code_information": [ { "code": "182", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major chest trauma with mcc", "code_information": [ { "code": "183", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major chest trauma with cc", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major chest trauma without cc/mcc", "code_information": [ { "code": "185", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pleural effusion with mcc", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pleural effusion with cc", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pleural effusion without cc/mcc", "code_information": [ { "code": "188", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pulmonary edema and respiratory failure", "code_information": [ { "code": "189", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Chronic obstructive pulmonary disease with mcc", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Chronic obstructive pulmonary disease with cc", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Chronic obstructive pulmonary disease without cc/mcc", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Simple pneumonia and pleurisy with mcc", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Simple pneumonia and pleurisy with cc", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Simple pneumonia and pleurisy without cc/mcc", "code_information": [ { "code": "195", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Interstitial lung disease with mcc", "code_information": [ { "code": "196", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Interstitial lung disease with cc", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Interstitial lung disease without cc/mcc", "code_information": [ { "code": "198", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pneumothorax with mcc", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pneumothorax with cc", "code_information": [ { "code": "200", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pneumothorax without cc/mcc", "code_information": [ { "code": "201", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bronchitis and asthma with cc/mcc", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bronchitis and asthma without cc/mcc", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory signs and symptoms", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other respiratory system diagnoses with mcc", "code_information": [ { "code": "205", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other respiratory system diagnoses without mcc", "code_information": [ { "code": "206", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory system diagnosis with ventilator support >96 hours", "code_information": [ { "code": "207", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Respiratory system diagnosis with ventilator support <=96 hours", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Complex aortic arch procedures", "code_information": [ { "code": "209", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Concomitant aortic and mitral valve procedures", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Endovascular abdominal aorta with iliac branch procedures", "code_information": [ { "code": "213", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other heart assist system implant", "code_information": [ { "code": "215", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac valve and other major cardiothoracic procedures with cardiac", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac valve and other major cardiothoracic procedures with cardiac", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac valve and other major cardiothoracic procedures with cardiac", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac valve and other major cardiothoracic procedures without card", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac valve and other major cardiothoracic procedures without card", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac valve and other major cardiothoracic procedures without card", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other cardiothoracic procedures with mcc", "code_information": [ { "code": "228", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other cardiothoracic procedures without mcc", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary bypass with ptca with mcc", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary bypass with ptca without mcc", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary bypass with cardiac catheterization or open ablation with m", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary bypass with cardiac catheterization or open ablation withou", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary bypass without cardiac catheterization with mcc", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary bypass without cardiac catheterization without mcc", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation for circulatory system disorders except upper limb and to", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation for circulatory system disorders except upper limb and to", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation for circulatory system disorders except upper limb and to", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Permanent cardiac pacemaker implant with mcc", "code_information": [ { "code": "242", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Permanent cardiac pacemaker implant with cc", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Permanent cardiac pacemaker implant without cc/mcc", "code_information": [ { "code": "244", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aicd generator procedures", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous cardiovascular procedures without intraluminal device w", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous cardiovascular procedures without intraluminal device w", "code_information": [ { "code": "251", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other vascular procedures with mcc", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other vascular procedures with cc", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other vascular procedures without cc/mcc", "code_information": [ { "code": "254", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Upper limb and toe amputation for circulatory system disorders with", "code_information": [ { "code": "255", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Upper limb and toe amputation for circulatory system disorders with", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Upper limb and toe amputation for circulatory system disorders witho", "code_information": [ { "code": "257", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac pacemaker device replacement with mcc", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac pacemaker device replacement without mcc", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac pacemaker revision except device replacement with mcc", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac pacemaker revision except device replacement with cc", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac pacemaker revision except device replacement without cc/mcc", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Vein ligation and stripping", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other circulatory system o.r. procedures", "code_information": [ { "code": "264", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aicd lead procedures", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Endovascular cardiac valve replacement and supplement procedures wit", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Endovascular cardiac valve replacement and supplement procedures wit", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aortic and heart assist procedures except pulsation balloon with mcc", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aortic and heart assist procedures except pulsation balloon without", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other major cardiovascular procedures with mcc", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other major cardiovascular procedures with cc", "code_information": [ { "code": "271", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other major cardiovascular procedures without cc/mcc", "code_information": [ { "code": "272", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous and other intracardiac procedures with mcc", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous and other intracardiac procedures without mcc", "code_information": [ { "code": "274", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac defibrillator implant with cardiac catheterization and mcc", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac defibrillator implant with mcc or carotid sinus neurostimula", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac defibrillator implant without mcc", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ultrasound accelerated and other thrombolysis of peripheral vascular", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Ultrasound accelerated and other thrombolysis of peripheral vascular", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute myocardial infarction, discharged alive with mcc", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute myocardial infarction, discharged alive with cc", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute myocardial infarction, discharged alive without cc/mcc", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute myocardial infarction, expired with mcc", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute myocardial infarction, expired with cc", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute myocardial infarction, expired without cc/mcc", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Circulatory disorders except ami, with cardiac catheterization with", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Circulatory disorders except ami, with cardiac catheterization with", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute and subacute endocarditis with mcc", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute and subacute endocarditis with cc", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Acute and subacute endocarditis without cc/mcc", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Heart failure and shock with mcc", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Heart failure and shock with cc", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Heart failure and shock without cc/mcc", "code_information": [ { "code": "293", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Deep vein thrombophlebitis with cc/mcc", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Deep vein thrombophlebitis without cc/mcc", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac arrest, unexplained with mcc", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac arrest, unexplained with cc", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac arrest, unexplained without cc/mcc", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peripheral vascular disorders with mcc", "code_information": [ { "code": "299", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peripheral vascular disorders with cc", "code_information": [ { "code": "300", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peripheral vascular disorders without cc/mcc", "code_information": [ { "code": "301", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Atherosclerosis with mcc", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Atherosclerosis without mcc", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hypertension with mcc", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hypertension without mcc", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac congenital and valvular disorders with mcc", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac congenital and valvular disorders without mcc", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac arrhythmia and conduction disorders with mcc", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac arrhythmia and conduction disorders with cc", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cardiac arrhythmia and conduction disorders without cc/mcc", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Angina pectoris", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Syncope and collapse", "code_information": [ { "code": "312", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Chest pain", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other circulatory system diagnoses with mcc", "code_information": [ { "code": "314", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other circulatory system diagnoses with cc", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other circulatory system diagnoses without cc/mcc", "code_information": [ { "code": "316", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Concomitant left atrial appendage closure and cardiac ablation", "code_information": [ { "code": "317", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous coronary atherectomy without intraluminal device", "code_information": [ { "code": "318", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other endovascular cardiac valve procedures with mcc", "code_information": [ { "code": "319", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other endovascular cardiac valve procedures without mcc", "code_information": [ { "code": "320", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous cardiovascular procedures with intraluminal device with", "code_information": [ { "code": "321", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous cardiovascular procedures with intraluminal device with", "code_information": [ { "code": "322", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary intravascular lithotripsy with intraluminal device with mcc", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary intravascular lithotripsy with intraluminal device without", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Coronary intravascular lithotripsy without intraluminal device", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Stomach, esophageal and duodenal procedures with mcc", "code_information": [ { "code": "326", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Stomach, esophageal and duodenal procedures with cc", "code_information": [ { "code": "327", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Stomach, esophageal and duodenal procedures without cc/mcc", "code_information": [ { "code": "328", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major small and large bowel procedures with mcc", "code_information": [ { "code": "329", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major small and large bowel procedures with cc", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major small and large bowel procedures without cc/mcc", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Rectal resection with mcc", "code_information": [ { "code": "332", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Rectal resection with cc", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Rectal resection without cc/mcc", "code_information": [ { "code": "334", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peritoneal adhesiolysis with mcc", "code_information": [ { "code": "335", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peritoneal adhesiolysis with cc", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Peritoneal adhesiolysis without cc/mcc", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Minor small and large bowel procedures with mcc", "code_information": [ { "code": "344", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Minor small and large bowel procedures with cc", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Minor small and large bowel procedures without cc/mcc", "code_information": [ { "code": "346", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Anal and stomal procedures with mcc", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Anal and stomal procedures with cc", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Anal and stomal procedures without cc/mcc", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Inguinal and femoral hernia procedures with mcc", "code_information": [ { "code": "350", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Inguinal and femoral hernia procedures with cc", "code_information": [ { "code": "351", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Inguinal and femoral hernia procedures without cc/mcc", "code_information": [ { "code": "352", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hernia procedures except inguinal and femoral with mcc", "code_information": [ { "code": "353", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hernia procedures except inguinal and femoral with cc", "code_information": [ { "code": "354", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hernia procedures except inguinal and femoral without cc/mcc", "code_information": [ { "code": "355", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other digestive system o.r. procedures with mcc", "code_information": [ { "code": "356", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other digestive system o.r. procedures with cc", "code_information": [ { "code": "357", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other digestive system o.r. procedures without cc/mcc", "code_information": [ { "code": "358", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous coronary atherectomy with intraluminal device with mcc", "code_information": [ { "code": "359", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Percutaneous coronary atherectomy with intraluminal device without m", "code_information": [ { "code": "360", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major esophageal disorders with mcc", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major esophageal disorders with cc", "code_information": [ { "code": "369", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major esophageal disorders without cc/mcc", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major gastrointestinal disorders and peritoneal infections with mcc", "code_information": [ { "code": "371", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major gastrointestinal disorders and peritoneal infections with cc", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major gastrointestinal disorders and peritoneal infections without c", "code_information": [ { "code": "373", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Digestive malignancy with mcc", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Digestive malignancy with cc", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Digestive malignancy without cc/mcc", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Gastrointestinal hemorrhage with mcc", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Gastrointestinal hemorrhage with cc", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Gastrointestinal hemorrhage without cc/mcc", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Complicated peptic ulcer with mcc", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Complicated peptic ulcer with cc", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Complicated peptic ulcer without cc/mcc", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Uncomplicated peptic ulcer with mcc", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Uncomplicated peptic ulcer without mcc", "code_information": [ { "code": "384", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Inflammatory bowel disease with mcc", "code_information": [ { "code": "385", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Inflammatory bowel disease with cc", "code_information": [ { "code": "386", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Inflammatory bowel disease without cc/mcc", "code_information": [ { "code": "387", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Gastrointestinal obstruction with mcc", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Gastrointestinal obstruction with cc", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Gastrointestinal obstruction without cc/mcc", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Esophagitis, gastroenteritis and miscellaneous digestive disorders", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Esophagitis, gastroenteritis and miscellaneous digestive disorders", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other digestive system diagnoses with mcc", "code_information": [ { "code": "393", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other digestive system diagnoses with cc", "code_information": [ { "code": "394", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other digestive system diagnoses without cc/mcc", "code_information": [ { "code": "395", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Appendix procedures with mcc", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Appendix procedures with cc", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Appendix procedures without cc/mcc", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Single level combined anterior and posterior spinal fusion except ce", "code_information": [ { "code": "402", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pancreas, liver and shunt procedures with mcc", "code_information": [ { "code": "405", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pancreas, liver and shunt procedures with cc", "code_information": [ { "code": "406", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pancreas, liver and shunt procedures without cc/mcc", "code_information": [ { "code": "407", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Biliary tract procedures except only cholecystectomy with or without", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Biliary tract procedures except only cholecystectomy with or without", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Biliary tract procedures except only cholecystectomy with or without", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cholecystectomy with c.d.e. with mcc", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cholecystectomy with c.d.e. with cc", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cholecystectomy with c.d.e. without cc/mcc", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cholecystectomy except by laparoscope without c.d.e. with mcc", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cholecystectomy except by laparoscope without c.d.e. with cc", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cholecystectomy except by laparoscope without c.d.e. without cc/mcc", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Laparoscopic cholecystectomy without c.d.e. with mcc", "code_information": [ { "code": "417", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Laparoscopic cholecystectomy without c.d.e. with cc", "code_information": [ { "code": "418", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Laparoscopic cholecystectomy without c.d.e. without cc/mcc", "code_information": [ { "code": "419", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hepatobiliary diagnostic procedures with mcc", "code_information": [ { "code": "420", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hepatobiliary diagnostic procedures with cc", "code_information": [ { "code": "421", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hepatobiliary diagnostic procedures without cc/mcc", "code_information": [ { "code": "422", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other hepatobiliary or pancreas o.r. procedures with mcc", "code_information": [ { "code": "423", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other hepatobiliary or pancreas o.r. procedures with cc", "code_information": [ { "code": "424", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other hepatobiliary or pancreas o.r. procedures without cc/mcc", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple level combined anterior and posterior spinal fusion except", "code_information": [ { "code": "426", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple level combined anterior and posterior spinal fusion except", "code_information": [ { "code": "427", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple level combined anterior and posterior spinal fusion except", "code_information": [ { "code": "428", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Combined anterior and posterior cervical spinal fusion with mcc", "code_information": [ { "code": "429", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Combined anterior and posterior cervical spinal fusion without mcc", "code_information": [ { "code": "430", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cirrhosis and alcoholic hepatitis with mcc", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cirrhosis and alcoholic hepatitis with cc", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cirrhosis and alcoholic hepatitis without cc/mcc", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Malignancy of hepatobiliary system or pancreas with mcc", "code_information": [ { "code": "435", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Malignancy of hepatobiliary system or pancreas with cc", "code_information": [ { "code": "436", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Malignancy of hepatobiliary system or pancreas without cc/mcc", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of pancreas except malignancy with mcc", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of pancreas except malignancy with cc", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of pancreas except malignancy without cc/mcc", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of liver except malignancy, cirrhosis or alcoholic hepati", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of liver except malignancy, cirrhosis or alcoholic hepati", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of liver except malignancy, cirrhosis or alcoholic hepati", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of the biliary tract with mcc", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of the biliary tract with cc", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Disorders of the biliary tract without cc/mcc", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple level spinal fusion except cervical with mcc or custom-made", "code_information": [ { "code": "447", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Multiple level spinal fusion except cervical without mcc", "code_information": [ { "code": "448", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Single level spinal fusion except cervical with mcc or custom-made a", "code_information": [ { "code": "450", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Single level spinal fusion except cervical without mcc", "code_information": [ { "code": "451", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Combined anterior and posterior spinal fusion with mcc", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Combined anterior and posterior spinal fusion with cc", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Combined anterior and posterior spinal fusion without cc/mcc", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal fusion except cervical with spinal curvature, malignancy, in", "code_information": [ { "code": "456", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal fusion except cervical with spinal curvature, malignancy, in", "code_information": [ { "code": "457", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal fusion except cervical with spinal curvature, malignancy, in", "code_information": [ { "code": "458", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal fusion except cervical with mcc", "code_information": [ { "code": "459", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Spinal fusion except cervical without mcc", "code_information": [ { "code": "460", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bilateral or multiple major joint procedures of lower extremity with", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bilateral or multiple major joint procedures of lower extremity with", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Wound debridement and skin graft except hand for musculoskeletal and", "code_information": [ { "code": "463", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Wound debridement and skin graft except hand for musculoskeletal and", "code_information": [ { "code": "464", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Wound debridement and skin graft except hand for musculoskeletal and", "code_information": [ { "code": "465", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Revision of hip or knee replacement with mcc", "code_information": [ { "code": "466", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Revision of hip or knee replacement with cc", "code_information": [ { "code": "467", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Revision of hip or knee replacement without cc/mcc", "code_information": [ { "code": "468", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major hip and knee joint replacement or reattachment of lower extrem", "code_information": [ { "code": "469", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major hip and knee joint replacement or reattachment of lower extrem", "code_information": [ { "code": "470", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cervical spinal fusion with mcc", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cervical spinal fusion with cc", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cervical spinal fusion without cc/mcc", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation for musculoskeletal system and connective tissue disorder", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation for musculoskeletal system and connective tissue disorder", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation for musculoskeletal system and connective tissue disorder", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Biopsies of musculoskeletal system and connective tissue with mcc", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Biopsies of musculoskeletal system and connective tissue with cc", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Biopsies of musculoskeletal system and connective tissue without cc/", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hip and femur procedures except major joint with mcc", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hip and femur procedures except major joint with cc", "code_information": [ { "code": "481", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hip and femur procedures except major joint without cc/mcc", "code_information": [ { "code": "482", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major joint or limb reattachment procedures of upper extremities", "code_information": [ { "code": "483", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Knee procedures with principal diagnosis of infection with mcc", "code_information": [ { "code": "485", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Knee procedures with principal diagnosis of infection with cc", "code_information": [ { "code": "486", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Knee procedures with principal diagnosis of infection without cc/mcc", "code_information": [ { "code": "487", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Knee procedures without principal diagnosis of infection with cc/mcc", "code_information": [ { "code": "488", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Knee procedures without principal diagnosis of infection without cc/", "code_information": [ { "code": "489", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Lower extremity and humerus procedures except hip, foot and femur w", "code_information": [ { "code": "492", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Lower extremity and humerus procedures except hip, foot and femur w", "code_information": [ { "code": "493", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Lower extremity and humerus procedures except hip, foot and femur w", "code_information": [ { "code": "494", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Local excision and removal of internal fixation devices except hip a", "code_information": [ { "code": "495", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Local excision and removal of internal fixation devices except hip a", "code_information": [ { "code": "496", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Local excision and removal of internal fixation devices except hip a", "code_information": [ { "code": "497", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Local excision and removal of internal fixation devices of hip and f", "code_information": [ { "code": "498", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Local excision and removal of internal fixation devices of hip and f", "code_information": [ { "code": "499", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Soft tissue procedures with mcc", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Soft tissue procedures with cc", "code_information": [ { "code": "501", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Soft tissue procedures without cc/mcc", "code_information": [ { "code": "502", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Foot procedures with mcc", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Foot procedures with cc", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Foot procedures without cc/mcc", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major thumb or joint procedures", "code_information": [ { "code": "506", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major shoulder or elbow joint procedures with cc/mcc", "code_information": [ { "code": "507", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major shoulder or elbow joint procedures without cc/mcc", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Arthroscopy", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Shoulder, elbow or forearm procedures, except major joint procedure", "code_information": [ { "code": "510", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Shoulder, elbow or forearm procedures, except major joint procedure", "code_information": [ { "code": "511", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Shoulder, elbow or forearm procedures, except major joint procedure", "code_information": [ { "code": "512", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hand or wrist procedures, except major thumb or joint procedures wi", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hand or wrist procedures, except major thumb or joint procedures wi", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other musculoskeletal system and connective tissue o.r. procedures w", "code_information": [ { "code": "515", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other musculoskeletal system and connective tissue o.r. procedures w", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other musculoskeletal system and connective tissue o.r. procedures w", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Back and neck procedures except spinal fusion with mcc or disc devic", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Back and neck procedures except spinal fusion with cc", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Back and neck procedures except spinal fusion without cc/mcc", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hip replacement with principal diagnosis of hip fracture with mcc", "code_information": [ { "code": "521", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Hip replacement with principal diagnosis of hip fracture without mcc", "code_information": [ { "code": "522", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Fractures of femur with mcc", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Fractures of femur without mcc", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Fractures of hip and pelvis with mcc", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Fractures of hip and pelvis without mcc", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Sprains, strains, and dislocations of hip, pelvis and thigh with cc", "code_information": [ { "code": "537", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Sprains, strains, and dislocations of hip, pelvis and thigh without", "code_information": [ { "code": "538", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Osteomyelitis with mcc", "code_information": [ { "code": "539", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Osteomyelitis with cc", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Osteomyelitis without cc/mcc", "code_information": [ { "code": "541", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pathological fractures and musculoskeletal and connective tissue mal", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pathological fractures and musculoskeletal and connective tissue mal", "code_information": [ { "code": "543", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Pathological fractures and musculoskeletal and connective tissue mal", "code_information": [ { "code": "544", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Connective tissue disorders with mcc", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Connective tissue disorders with cc", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Connective tissue disorders without cc/mcc", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Septic arthritis with mcc", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Septic arthritis with cc", "code_information": [ { "code": "549", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Septic arthritis without cc/mcc", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Medical back problems with mcc", "code_information": [ { "code": "551", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Medical back problems without mcc", "code_information": [ { "code": "552", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bone diseases and arthropathies with mcc", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Bone diseases and arthropathies without mcc", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Signs and symptoms of musculoskeletal system and connective tissue w", "code_information": [ { "code": "555", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Signs and symptoms of musculoskeletal system and connective tissue w", "code_information": [ { "code": "556", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Tendonitis, myositis and bursitis with mcc", "code_information": [ { "code": "557", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Tendonitis, myositis and bursitis without mcc", "code_information": [ { "code": "558", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aftercare, musculoskeletal system and connective tissue with mcc", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aftercare, musculoskeletal system and connective tissue with cc", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Aftercare, musculoskeletal system and connective tissue without cc/", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Fracture, sprain, strain and dislocation except femur, hip, pelvis", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Fracture, sprain, strain and dislocation except femur, hip, pelvis", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other musculoskeletal system and connective tissue diagnoses with mc", "code_information": [ { "code": "564", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other musculoskeletal system and connective tissue diagnoses with cc", "code_information": [ { "code": "565", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other musculoskeletal system and connective tissue diagnoses without", "code_information": [ { "code": "566", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin debridement with mcc", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin debridement with cc", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin debridement without cc/mcc", "code_information": [ { "code": "572", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin graft for skin ulcer or cellulitis with mcc", "code_information": [ { "code": "573", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin graft for skin ulcer or cellulitis with cc", "code_information": [ { "code": "574", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin graft for skin ulcer or cellulitis without cc/mcc", "code_information": [ { "code": "575", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin graft except for skin ulcer or cellulitis with mcc", "code_information": [ { "code": "576", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin graft except for skin ulcer or cellulitis with cc", "code_information": [ { "code": "577", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin graft except for skin ulcer or cellulitis without cc/mcc", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other skin, subcutaneous tissue and breast procedures with mcc", "code_information": [ { "code": "579", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other skin, subcutaneous tissue and breast procedures with cc", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Other skin, subcutaneous tissue and breast procedures without cc/mc", "code_information": [ { "code": "581", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Mastectomy for malignancy with cc/mcc", "code_information": [ { "code": "582", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Mastectomy for malignancy without cc/mcc", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Breast biopsy, local excision and other breast procedures with cc/m", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Breast biopsy, local excision and other breast procedures without c", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin ulcers with mcc", "code_information": [ { "code": "592", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin ulcers with cc", "code_information": [ { "code": "593", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Skin ulcers without cc/mcc", "code_information": [ { "code": "594", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major skin disorders with mcc", "code_information": [ { "code": "595", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Major skin disorders without mcc", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Malignant breast disorders with mcc", "code_information": [ { "code": "597", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Malignant breast disorders with cc", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Malignant breast disorders without cc/mcc", "code_information": [ { "code": "599", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Non-malignant breast disorders with cc/mcc", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Non-malignant breast disorders without cc/mcc", "code_information": [ { "code": "601", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cellulitis with mcc", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Cellulitis without mcc", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Trauma to the skin, subcutaneous tissue and breast with mcc", "code_information": [ { "code": "604", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Trauma to the skin, subcutaneous tissue and breast without mcc", "code_information": [ { "code": "605", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Minor skin disorders with mcc", "code_information": [ { "code": "606", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Minor skin disorders without mcc", "code_information": [ { "code": "607", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Adrenal and pituitary procedures with cc/mcc", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Adrenal and pituitary procedures without cc/mcc", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation of lower limb for endocrine, nutritional and metabolic d", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation of lower limb for endocrine, nutritional and metabolic d", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" } ] } ] }, { "description": "Amputation of lower limb for endocrine, nutritional and metabolic d", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Carelon Behavioral Health (Elevance Health)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" },