{ "hospital_name": "Thorek Memorial Hospital", "last_updated_on": "2026-02-24", "version": "3.0.0", "location_name": [ "Thorek Memorial Hospital" ], "hospital_address": [ "850 W Irving Park Rd, Chicago, IL 60613" ], "license_information": { "license_number": "0005317", "state": "IL" }, "type_2_npi": [ "1982643961" ], "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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 10965.97, "maximum": 10965.97, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10965.97, "median_amount": 10965.97, "90th_percentile": 10965.97 }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7270.59, "maximum": 9261.75, "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": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7270.59, "median_amount": 7270.59, "90th_percentile": 9261.75 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 9615.32, "maximum": 9615.32, "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.", "count": "1 through 10", "10th_percentile": 9615.32, "median_amount": 9615.32, "90th_percentile": 9615.32 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 8654.08, "maximum": 8835.46, "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": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8654.08, "median_amount": 8654.08, "90th_percentile": 8835.46 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 3489.83, "maximum": 4316.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3489.83, "median_amount": 3489.83, "90th_percentile": 3489.83 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4316.86, "median_amount": 4316.86, "90th_percentile": 4316.86 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 46.13, "maximum": 14298.43, "payers_information": [ { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 46.13, "median_amount": 46.13, "90th_percentile": 14298.43 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 13223.16, "median_amount": 13223.16, "90th_percentile": 13223.16 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 5679.75, "maximum": 15984.08, "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.", "count": "1 through 10", "10th_percentile": 15984.08, "median_amount": 15984.08, "90th_percentile": 15984.08 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5679.75, "median_amount": 5679.75, "90th_percentile": 5679.75 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6545.58, "median_amount": 6545.58, "90th_percentile": 6545.58 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7220.71, "maximum": 9006.56, "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.", "count": "1 through 10", "10th_percentile": 7220.71, "median_amount": 7220.71, "90th_percentile": 9006.56 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 8774.02, "maximum": 8774.02, "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", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8774.02, "median_amount": 8774.02, "90th_percentile": 8774.02 }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 321.17, "maximum": 7880.95, "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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7880.95, "median_amount": 7880.95, "90th_percentile": 7880.95 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 321.17, "median_amount": 321.17, "90th_percentile": 321.17 }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7361.61, "median_amount": 7361.61, "90th_percentile": 7361.61 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7361.61, "median_amount": 7361.61, "90th_percentile": 7361.61 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 5347.97, "maximum": 5347.97, "payers_information": [ { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5347.97, "median_amount": 5347.97, "90th_percentile": 5347.97 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 26140.22, "maximum": 26140.22, "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 26140.22, "median_amount": 26140.22, "90th_percentile": 26140.22 }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1469.26, "maximum": 16595.63, "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.", "count": "1 through 10", "10th_percentile": 1469.26, "median_amount": 1469.26, "90th_percentile": 16595.63 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 6230.9, "maximum": 14507.28, "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": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 14507.28, "median_amount": 14507.28, "90th_percentile": 14507.28 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6230.9, "median_amount": 6230.9, "90th_percentile": 6294.03 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 15257.95, "maximum": 17285.48, "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": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 17285.48, "median_amount": 17285.48, "90th_percentile": 17285.48 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 15257.95, "median_amount": 15257.95, "90th_percentile": 15257.95 }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 3636.7, "maximum": 6676.15, "payers_information": [ { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6676.15, "median_amount": 6676.15, "90th_percentile": 6676.15 }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3636.7, "median_amount": 3636.7, "90th_percentile": 3636.7 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 4921.81, "maximum": 4921.81, "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.", "count": "1 through 10", "10th_percentile": 4921.81, "median_amount": 4921.81, "90th_percentile": 4921.81 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 11810.41, "maximum": 11810.41, "payers_information": [ { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 11810.41, "median_amount": 11810.41, "90th_percentile": 11810.41 }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 13743.42, "maximum": 13743.42, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 13743.42, "median_amount": 13743.42, "90th_percentile": 13743.42 } ] } ] }, { "description": "Dental and oral diseases with cc", "code_information": [ { "code": "158", "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": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1438.92, "maximum": 63457.97, "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1438.92, "median_amount": 1438.92, "90th_percentile": 6994.26 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 12160.4, "median_amount": 12160.4, "90th_percentile": 63457.97 } ] } ] }, { "description": "Respiratory infections and inflammations with mcc", "code_information": [ { "code": "177", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35.35, "maximum": 23598.7, "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.", "count": "1 through 10", "10th_percentile": 23598.7, "median_amount": 23598.7, "90th_percentile": 23598.7 }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8283.35, "median_amount": 8283.35, "90th_percentile": 8283.35 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 35.35, "median_amount": 11928.73, "90th_percentile": 13583.69 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 6808.23, "maximum": 21688.08, "payers_information": [ { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 21688.08, "median_amount": 21688.08, "90th_percentile": 21688.08 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6808.23, "median_amount": 6808.23, "90th_percentile": 6906.69 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 22479.83, "maximum": 70611.36, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 22479.83, "median_amount": 30506.39, "90th_percentile": 70611.36 } ] } ] }, { "description": "Respiratory neoplasms with mcc", "code_information": [ { "code": "180", "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", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1705.11, "maximum": 1705.11, "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": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1705.11, "median_amount": 1705.11, "90th_percentile": 1705.11 }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1661.51, "maximum": 10714.32, "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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1661.51, "median_amount": 10462.33, "90th_percentile": 10462.33 }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10714.32, "median_amount": 10714.32, "90th_percentile": 10714.32 }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10714.32, "median_amount": 10714.32, "90th_percentile": 10714.32 }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 8005.95, "maximum": 16995.24, "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": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8568.67, "median_amount": 8568.67, "90th_percentile": 8568.67 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8005.95, "median_amount": 8005.95, "90th_percentile": 16995.24 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 5717.54, "maximum": 7360.02, "payers_information": [ { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5717.54, "median_amount": 5723.39, "90th_percentile": 7360.02 } ] } ] }, { "description": "Chronic obstructive pulmonary disease without cc/mcc", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4714.28, "maximum": 4714.28, "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": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4714.28, "median_amount": 4714.28, "90th_percentile": 4714.28 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 688.99, "maximum": 61358.36, "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9487.35, "median_amount": 9487.35, "90th_percentile": 9487.35 }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9487.35, "median_amount": 9487.35, "90th_percentile": 9487.35 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 688.99, "median_amount": 9672.41, "90th_percentile": 11129.83 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 17976.47, "median_amount": 24389.89, "90th_percentile": 61358.36 }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9954.42, "median_amount": 9954.42, "90th_percentile": 9954.42 } ] } ] }, { "description": "Simple pneumonia and pleurisy with cc", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 507.65, "maximum": 49365.4, "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.", "count": "1 through 10", "10th_percentile": 16979.57, "median_amount": 29390.01, "90th_percentile": 49365.4 }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6172.06, "median_amount": 6172.06, "90th_percentile": 6172.06 }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4913.46, "median_amount": 4913.46, "90th_percentile": 4913.46 }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5104.01, "median_amount": 5104.01, "90th_percentile": 5104.01 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "18", "10th_percentile": 632.52, "median_amount": 5486.9, "90th_percentile": 7129.38 }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5286.74, "median_amount": 5286.74, "90th_percentile": 5286.74 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5218.73, "median_amount": 5218.73, "90th_percentile": 5218.73 }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7017.22, "median_amount": 7017.22, "90th_percentile": 7017.22 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6833.61, "median_amount": 6833.61, "90th_percentile": 6833.61 }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 3778.89, "maximum": 27273.68, "payers_information": [ { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5262.84, "median_amount": 5262.84, "90th_percentile": 5262.84 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 27273.68, "median_amount": 27273.68, "90th_percentile": 27273.68 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3778.89, "median_amount": 3778.89, "90th_percentile": 3778.89 }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3778.89, "median_amount": 3778.89, "90th_percentile": 3783.69 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3778.89, "median_amount": 3778.89, "90th_percentile": 3783.69 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 6606.52, "maximum": 22595.74, "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": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6606.52, "median_amount": 6606.52, "90th_percentile": 6606.52 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 22595.74, "median_amount": 22595.74, "90th_percentile": 22595.74 }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7995.14, "median_amount": 7995.14, "90th_percentile": 7995.14 }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 13727.41, "maximum": 37367.08, "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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 13727.41, "median_amount": 13727.41, "90th_percentile": 13727.41 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 37367.08, "median_amount": 37367.08, "90th_percentile": 37367.08 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 325.42, "maximum": 41894.74, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 325.42, "median_amount": 325.42, "90th_percentile": 325.42 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 41894.74, "median_amount": 41894.74, "90th_percentile": 41894.74 }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 6100.5, "maximum": 20304.46, "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.", "count": "1 through 10", "10th_percentile": 20304.46, "median_amount": 20304.46, "90th_percentile": 20304.46 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6100.5, "median_amount": 6100.5, "90th_percentile": 6615.37 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 20209.24, "maximum": 54111.7, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 20209.24, "median_amount": 25177.85, "90th_percentile": 54111.7 }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 54111.7, "median_amount": 54111.7, "90th_percentile": 54111.7 } ] } ] }, { "description": "Respiratory system diagnosis with ventilator support <=96 hours", "code_information": [ { "code": "208", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21702.99, "maximum": 136249.74, "payers_information": [ { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 21702.99, "median_amount": 22323.8, "90th_percentile": 23345.47 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 136249.74, "median_amount": 136249.74, "90th_percentile": 136249.74 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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 of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 22037.12, "maximum": 22037.12, "payers_information": [ { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 22037.12, "median_amount": 22037.12, "90th_percentile": 22037.12 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 8014.4, "maximum": 23868.58, "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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8014.4, "median_amount": 8014.4, "90th_percentile": 23868.58 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 44308.63, "maximum": 44308.63, "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.", "count": "1 through 10", "10th_percentile": 44308.63, "median_amount": 44308.63, "90th_percentile": 44308.63 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ 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"Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 795.31, "maximum": 22780.4, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 795.31, "median_amount": 795.31, "90th_percentile": 795.31 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 22780.4, "median_amount": 22780.4, "90th_percentile": 22780.4 } ] } ] }, { "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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 23228.35, "maximum": 23228.35, "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": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 23228.35, "median_amount": 23228.35, "90th_percentile": 23228.35 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 840.12, "maximum": 6231.72, "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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 840.12, "median_amount": 840.12, "90th_percentile": 6231.72 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 5660.01, "maximum": 5660.01, "payers_information": [ { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5660.01, "median_amount": 5660.01, "90th_percentile": 5660.01 }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7729.51, "maximum": 7729.51, "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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7729.51, "median_amount": 7729.51, "90th_percentile": 7729.51 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 176.93, "maximum": 15412.3, "payers_information": [ { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10006.47, "median_amount": 10006.47, "90th_percentile": 10006.47 }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9592.89, "median_amount": 9592.89, "90th_percentile": 9592.89 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "22", "10th_percentile": 8553.19, "median_amount": 9475.82, "90th_percentile": 11118.3 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 15412.3, "median_amount": 15412.3, "90th_percentile": 15412.3 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 133.39, "maximum": 5734.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3156.7, "median_amount": 3156.7, "90th_percentile": 3156.7 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 133.39, "median_amount": 133.39, "90th_percentile": 5734.75 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 4814.52, "maximum": 4814.52, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4814.52, "median_amount": 4814.52, "90th_percentile": 4814.52 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1066.17, "maximum": 11950.25, "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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1066.17, "median_amount": 1066.17, "90th_percentile": 11950.25 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7451.97, "maximum": 23346.49, "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": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7451.97, "median_amount": 8817.93, "90th_percentile": 9094.45 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 23346.49, "median_amount": 23346.49, "90th_percentile": 23346.49 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 6409.89, "maximum": 31565.57, "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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 31565.57, "median_amount": 31565.57, "90th_percentile": 31565.57 }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 12021.08, "median_amount": 12021.08, "90th_percentile": 12021.08 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6409.89, "median_amount": 6409.89, "90th_percentile": 6409.89 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 4828.59, "maximum": 4828.59, "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": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4828.59, "median_amount": 4828.59, "90th_percentile": 4828.59 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 8268.51, "maximum": 9273.01, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8268.51, "median_amount": 8268.51, "90th_percentile": 8268.51 }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9273.01, "median_amount": 9273.01, "90th_percentile": 9273.01 } ] } ] }, { "description": "Cardiac arrhythmia and conduction disorders with cc", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2437.23, "maximum": 6543.43, "payers_information": [ { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 2437.23, "median_amount": 5556.33, "90th_percentile": 6543.43 }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 4560.03, "maximum": 4560.03, "payers_information": [ { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4560.03, "median_amount": 4560.03, "90th_percentile": 4560.03 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1348.08, "maximum": 7460.06, "payers_information": [ { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7242.03, "median_amount": 7242.03, "90th_percentile": 7242.03 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1348.08, "median_amount": 5817.58, "90th_percentile": 7460.06 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1273.17, "maximum": 6170.68, "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": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 2570.9, "median_amount": 2570.9, "90th_percentile": 2570.9 }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 5748.67, "median_amount": 5748.67, "90th_percentile": 5748.67 }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6165.17, "median_amount": 6165.17, "90th_percentile": 6170.68 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1273.17, "median_amount": 1877.47, "90th_percentile": 4769.9 }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4769.9, "median_amount": 4769.9, "90th_percentile": 4769.9 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4769.9, "median_amount": 4769.9, "90th_percentile": 4769.9 }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3757.26, "median_amount": 3757.26, "90th_percentile": 3757.26 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 1170.1, "maximum": 17974.98, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 1170.1, "median_amount": 17974.98, "90th_percentile": 17974.98 }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7297.97, "median_amount": 7297.97, "90th_percentile": 16969.59 } ] } ] }, { "description": "Other circulatory system diagnoses with cc", "code_information": [ { "code": "315", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4517.58, "maximum": 8443.16, "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.", "count": "1 through 10", "10th_percentile": 4517.58, "median_amount": 6800.68, "90th_percentile": 8443.16 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 8206.33, "median_amount": 8206.33, "90th_percentile": 8206.33 } ] } ] }, { "description": "Other circulatory system diagnoses without cc/mcc", "code_information": [ { "code": "316", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4907.4, "maximum": 4907.4, "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": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4907.4, "median_amount": 4907.4, "90th_percentile": 4907.4 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 24032.1, "maximum": 24032.1, "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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 24032.1, "median_amount": 24032.1, "90th_percentile": 24032.1 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 9000.0, "maximum": 67749.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9000.0, "median_amount": 9000.0, "90th_percentile": 9000.0 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 67749.32, "median_amount": 67749.32, "90th_percentile": 67749.32 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 47801.26, "median_amount": 47801.26, "90th_percentile": 47801.26 }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 18769.11, "maximum": 30836.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 30836.09, "median_amount": 30836.09, "90th_percentile": 30836.09 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 18769.11, "median_amount": 18769.11, "90th_percentile": 18769.11 } ] } ] }, { "description": "Major small and large bowel procedures without cc/mcc", "code_information": [ { "code": "331", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13277.39, "maximum": 13455.16, "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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 13455.16, "median_amount": 13455.16, "90th_percentile": 13455.16 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 13277.39, "median_amount": 13277.39, "90th_percentile": 13277.39 } ] } ] }, { "description": "Rectal resection with mcc", "code_information": [ { "code": "332", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "payers_information": [ { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 19294.21, "maximum": 19294.21, "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": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 19294.21, "median_amount": 19294.21, "90th_percentile": 19294.21 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 16925.55, "maximum": 16925.55, "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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 16925.55, "median_amount": 16925.55, "90th_percentile": 16925.55 } ] } ] }, { "description": "Peritoneal adhesiolysis without cc/mcc", "code_information": [ { "code": "337", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 741.9, "maximum": 11720.63, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 11720.63, "median_amount": 11720.63, "90th_percentile": 11720.63 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 741.9, "median_amount": 741.9, "90th_percentile": 741.9 }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 20769.08, "maximum": 20769.08, "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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 20769.08, "median_amount": 20769.08, "90th_percentile": 20769.08 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 20769.08, "median_amount": 20769.08, "90th_percentile": 20769.08 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 32063.99, "maximum": 32063.99, "payers_information": [ { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 32063.99, "median_amount": 32063.99, "90th_percentile": 32063.99 } ] } ] }, { "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": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 24706.78, "maximum": 24706.78, "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": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 24706.78, "median_amount": 24706.78, "90th_percentile": 24706.78 }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 23858.73, "maximum": 23858.73, "payers_information": [ { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 23858.73, "median_amount": 23858.73, "90th_percentile": 23858.73 }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 63990.16, "maximum": 63990.16, "payers_information": [ { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 63990.16, "median_amount": 63990.16, "90th_percentile": 63990.16 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7025.21, "maximum": 7025.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7025.21, "median_amount": 7025.21, "90th_percentile": 7025.21 }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7760.69, "maximum": 10542.64, "payers_information": [ { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 9014.92, "median_amount": 9014.92, "90th_percentile": 9014.92 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10542.64, "median_amount": 10542.64, "90th_percentile": 10542.64 }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7760.69, "median_amount": 7760.69, "90th_percentile": 7760.69 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 11700.77, "maximum": 11700.77, "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": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 11700.77, "median_amount": 11700.77, "90th_percentile": 11700.77 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 15660.99, "maximum": 18253.97, "payers_information": [ { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 15660.99, "median_amount": 15660.99, "90th_percentile": 15660.99 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 18253.97, "median_amount": 18253.97, "90th_percentile": 18253.97 } ] } ] }, { "description": "Digestive malignancy with cc", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29153.88, "maximum": 29153.88, "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": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 29153.88, "median_amount": 29153.88, "90th_percentile": 29153.88 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 153.17, "maximum": 25509.06, "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": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 13887.31, "median_amount": 13887.31, "90th_percentile": 13887.31 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 153.17, "median_amount": 15225.28, "90th_percentile": 25509.06 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 15225.28, "median_amount": 15225.28, "90th_percentile": 15225.28 }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 6323.27, "maximum": 64273.71, "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.", "count": "1 through 10", "10th_percentile": 10177.41, "median_amount": 10177.41, "90th_percentile": 10177.41 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 18702.62, "median_amount": 18702.62, "90th_percentile": 64273.71 }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6323.27, "median_amount": 6323.27, "90th_percentile": 6323.27 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6764.99, "median_amount": 6945.93, "90th_percentile": 8406.58 }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7922.01, "median_amount": 7922.01, "90th_percentile": 7922.01 } ] } ] }, { "description": "Gastrointestinal hemorrhage without cc/mcc", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2509.38, "maximum": 3893.71, "payers_information": [ { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 3893.71, "median_amount": 3893.71, "90th_percentile": 3893.71 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 2509.38, "median_amount": 2509.38, "90th_percentile": 2509.38 }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 896.15, "maximum": 10931.84, "payers_information": [ { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 6077.37, "median_amount": 6077.37, "90th_percentile": 6077.37 }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 896.15, "median_amount": 896.15, "90th_percentile": 9446.44 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10931.84, "median_amount": 10931.84, "90th_percentile": 10931.84 }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 10225.83, "maximum": 10225.83, "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.", "count": "1 through 10", "10th_percentile": 10225.83, "median_amount": 10225.83, "90th_percentile": 10225.83 }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 7641.91, "maximum": 7641.91, "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", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 7641.91, "median_amount": 7641.91, "90th_percentile": 7641.91 }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 4033.66, "maximum": 4033.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4033.66, "median_amount": 4033.66, "90th_percentile": 4033.66 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 372.47, "maximum": 12593.25, "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.", "count": "1 through 10", "10th_percentile": 6888.47, "median_amount": 6888.47, "90th_percentile": 6888.47 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 372.47, "median_amount": 5352.51, "90th_percentile": 5352.51 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 12593.25, "median_amount": 12593.25, "90th_percentile": 12593.25 }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 4802.23, "maximum": 10627.93, "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": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10627.93, "median_amount": 10627.93, "90th_percentile": 10627.93 }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 4802.23, "median_amount": 4802.23, "90th_percentile": 4802.23 }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 10848.58, "maximum": 12189.78, "payers_information": [ { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Cigna Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Centene (Ambetter)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Union", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Blue Cross Blue Shield", "plan_name": "HMO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Ascension", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna Better Health of Illinois", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Aetna", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Advocate Health", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Medicare", "plan_name": "Medicare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 10848.58, "median_amount": 10848.58, "90th_percentile": 10848.58 }, { "payer_name": "Blue Cross Blue Shield of Illinois", "plan_name": "PPO", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "count": "1 through 10", "10th_percentile": 12189.78, "median_amount": 12189.78, "90th_percentile": 12189.78 }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum 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", "minimum": 727.79, "maximum": 36660.38, "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.", "count": "1 through 10", "10th_percentile": 3086.75, "median_amount": 13168.5, "90th_percentile": 36660.38 }, { "payer_name": "Humana", "plan_name": "ChoiceCare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Humana", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Illinois Medicaid", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Longevity Health Plan", "plan_name": "Medicare Advantage (I-SNP)", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meridian Health Plan (Centene)", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Meritain Health (Aetna/CVS Health)", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Molina Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Other", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Provider Partners Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "UMR", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Commercial", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "United Healthcare", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellcare Health Plan", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Wellpath", "plan_name": "Correctional Healthcare", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Devoted Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "County Care Claims", "plan_name": "Medicaid", "methodology": "fee schedule", "standard_charge_algorithm": "Fee schedule/maximum allowable or contracted/legislated fee arrangement or not known in advance.", "additional_payer_notes": "No services performed during 12+ months lookup.", "count": "0" }, { "payer_name": "Clear Spring Health", "plan_name": "Medicare Advantage", "methodology": "fee schedule", "standard