hospital_name last_updated_on version hospital_location hospital_address license_number|MI "To the best of its knowledge and belief, the 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 indicated." "HMIH Cedar Crest, LLC" 5/31/2024 2.0.0 "Killeen, Texas" 2206 East Central Texas Expressway license_ 008216 | LA TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AETNA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA ]|[plan_ HMO/PPO] standard_charge|[payer_AETNA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_AETNA ]|[Plan_ HMO/PPO] standard_charge|[payer_AETNA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MCR ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AMBETTER HEALTH SUPERIOR ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER HEALTH SUPERIOR ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_AMBETTER HEALTH SUPERIOR ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMBETTER HEALTH SUPERIOR ]|[plan_ HMO/PPO] standard_charge|[payer_AMBETTER HEALTH SUPERIOR ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_AMBETTER HEALTH SUPERIOR ]|[Plan_ HMO/PPO] standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIGROUP MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIGROUP MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIGROUP MCR ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP STAR UHRIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP STAR UHRIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP STAR UHRIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP STAR UHRIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_AZ BANNER ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_AZ BANNER ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_AZ BANNER ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_AZ BANNER ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ BANNER ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_AZ BANNER ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ COMPLETE HEALTH ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_AZ COMPLETE HEALTH ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_AZ COMPLETE HEALTH ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_AZ COMPLETE HEALTH ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ COMPLETE HEALTH ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_AZ COMPLETE HEALTH ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ DCS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_AZ DCS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_AZ DCS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_AZ DCS ]|[plan_ LOCAL GOVT] standard_charge|[payer_AZ DCS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_AZ DCS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_AZ MERCY CARE ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_AZ MERCY CARE ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_AZ MERCY CARE ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_AZ MERCY CARE ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ MERCY CARE ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_AZ MERCY CARE ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ OPTUM ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_AZ OPTUM ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_AZ OPTUM ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_AZ OPTUM ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_AZ OPTUM ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_AZ OPTUM ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_BCBS ADVANTAGE HMO ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS ADVANTAGE HMO ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS ADVANTAGE HMO ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS ADVANTAGE HMO ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS ADVANTAGE HMO ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS ADVANTAGE HMO ]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS HMO ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS HMO ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS HMO ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS HMO ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS HMO ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS HMO ]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BCBS MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BCBS MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BCBS MCR ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS TEXAS HEALTH SELECT ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS HEALTH SELECT ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS TEXAS HEALTH SELECT ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS TEXAS HEALTH SELECT ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS TEXAS HEALTH SELECT ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS TEXAS HEALTH SELECT ]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS TEXAS PPO POS FED ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS PPO POS FED ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS TEXAS PPO POS FED ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS TEXAS PPO POS FED ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS TEXAS PPO POS FED ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS TEXAS PPO POS FED ]|[Plan_ BLUE CROSS] standard_charge|[payer_BEACON CHILDRENS MED CTR ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BEACON CHILDRENS MED CTR ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BEACON CHILDRENS MED CTR ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BEACON CHILDRENS MED CTR ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON CHILDRENS MED CTR ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BEACON CHILDRENS MED CTR ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON COMMUNITY HEALTH ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BEACON COMMUNITY HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BEACON COMMUNITY HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BEACON COMMUNITY HEALTH ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON COMMUNITY HEALTH ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BEACON COMMUNITY HEALTH ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON COOK CHILDRENS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BEACON COOK CHILDRENS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BEACON COOK CHILDRENS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BEACON COOK CHILDRENS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON COOK CHILDRENS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BEACON COOK CHILDRENS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS ]|[plan_ HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS ]|[Plan_ HMO/PPO] standard_charge|[payer_BEACON NORTH STAR MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BEACON NORTH STAR MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BEACON NORTH STAR MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BEACON NORTH STAR MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON NORTH STAR MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BEACON NORTH STAR MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON SENDERO HEALTH ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BEACON SENDERO HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BEACON SENDERO HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BEACON SENDERO HEALTH ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BEACON SENDERO HEALTH ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BEACON SENDERO HEALTH ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BELL COUNTY IHCP ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BELL COUNTY IHCP ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_BELL COUNTY IHCP ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_BELL COUNTY IHCP ]|[plan_ LOCAL GOVT] standard_charge|[payer_BELL COUNTY IHCP ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_BELL COUNTY IHCP ]|[Plan_ LOCAL GOVT] standard_charge|[payer_BELL LAMPASAS CO CSCD ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BELL LAMPASAS CO CSCD ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_BELL LAMPASAS CO CSCD ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_BELL LAMPASAS CO CSCD ]|[plan_ LOCAL GOVT] standard_charge|[payer_BELL LAMPASAS CO CSCD ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_BELL LAMPASAS CO CSCD ]|[Plan_ LOCAL GOVT] standard_charge|[payer_BLUEBONNET TRAILS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BLUEBONNET TRAILS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_BLUEBONNET TRAILS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_BLUEBONNET TRAILS ]|[plan_ LOCAL GOVT] standard_charge|[payer_BLUEBONNET TRAILS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_BLUEBONNET TRAILS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_CARELON BEHAVIORAL HEALTH ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CARELON BEHAVIORAL HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CARELON BEHAVIORAL HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CARELON BEHAVIORAL HEALTH ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_CARELON BEHAVIORAL HEALTH ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CARELON BEHAVIORAL HEALTH ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_CHAMPVA ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMPVA ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMPVA ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMPVA ]|[plan_ VETERANS ADMIN] standard_charge|[payer_CHAMPVA ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMPVA ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_CO ACCESS ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_CO ACCESS ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_CO ACCESS ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_CO ACCESS ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_CO ACCESS ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_CO ACCESS ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_CO BEACON ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO BEACON ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_CO BEACON ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_CO BEACON ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_CO BEACON ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_CO BEACON ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_CO CCHA ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO CCHA ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_CO CCHA ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_CO CCHA ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_CO CCHA ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_CO CCHA ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_CO EL PASO COUNTY ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CO EL PASO COUNTY ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_CO EL PASO COUNTY ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_CO EL PASO COUNTY ]|[plan_ LOCAL GOVT] standard_charge|[payer_CO EL PASO COUNTY ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_CO EL PASO COUNTY ]|[Plan_ LOCAL GOVT] standard_charge|[payer_CO EPDST ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO EPDST ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_CO EPDST ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_CO EPDST ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_CO EPDST ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_CO EPDST ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_CO HEALTH FIRST MCD ]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO HEALTH FIRST MCD ]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_CO HEALTH FIRST MCD ]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_CO HEALTH FIRST MCD ]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO HEALTH FIRST MCD ]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_CO HEALTH FIRST MCD ]|[Plan_MEDICAID: CBS OOS] standard_charge|[payer_CO WELD COUNTY MCD ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_CO WELD COUNTY MCD ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_CO WELD COUNTY MCD ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_CO WELD COUNTY MCD ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_CO WELD COUNTY MCD ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_CO WELD COUNTY MCD ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_COMMUN HLTH MARKETPLACE ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_COMMUN HLTH MARKETPLACE ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_COMMUN HLTH MARKETPLACE ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COMMUN HLTH MARKETPLACE ]|[plan_ HMO/PPO] standard_charge|[payer_COMMUN HLTH MARKETPLACE ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_COMMUN HLTH MARKETPLACE ]|[Plan_ HMO/PPO] standard_charge|[payer_COMMUN HLTH MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COMMUN HLTH MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_COMMUN HLTH MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_COMMUN HLTH MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_COMMUN HLTH MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_COMMUN HLTH MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_COMMUN HLTH MCR ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_COMMUN HLTH MCR ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_COMMUN HLTH MCR ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_COMMUN HLTH MCR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_COMMUN HLTH MCR ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_COMMUN HLTH MCR ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_COMPREHENSIVE BEH CARE ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_COMPREHENSIVE BEH CARE ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_COMPREHENSIVE BEH CARE ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_COMPREHENSIVE BEH CARE ]|[plan_ LOCAL GOVT] standard_charge|[payer_COMPREHENSIVE BEH CARE ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_COMPREHENSIVE BEH CARE ]|[Plan_ LOCAL GOVT] standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COMPSYCH ]|[plan_ HMO/PPO] standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_COMPSYCH ]|[Plan_ HMO/PPO] standard_charge|[payer_DFPS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DFPS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DFPS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DFPS ]|[plan_ LOCAL GOVT] standard_charge|[payer_DFPS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_DFPS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_DRISCOLL HEALTH PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_DRISCOLL HEALTH PLAN ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_DRISCOLL HEALTH PLAN ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_DRISCOLL HEALTH PLAN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_DRISCOLL HEALTH PLAN ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_DRISCOLL HEALTH PLAN ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_EVERNORTH HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_EVERNORTH HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_EVERNORTH HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_EVERNORTH HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_EVERNORTH HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_EVERNORTH HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_EVERNORTH MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_EVERNORTH MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_EVERNORTH MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_EVERNORTH MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_EVERNORTH MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_EVERNORTH MCR ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_FIRST HEALTH NETWORK ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_FIRST HEALTH NETWORK ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_FIRST HEALTH NETWORK ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FIRST HEALTH NETWORK ]|[plan_ HMO/PPO] standard_charge|[payer_FIRST HEALTH NETWORK ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_FIRST HEALTH NETWORK ]|[Plan_ HMO/PPO] standard_charge|[payer_FIRSTCARE HEALTH PLANS ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_FIRSTCARE HEALTH PLANS ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_FIRSTCARE HEALTH PLANS ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FIRSTCARE HEALTH PLANS ]|[plan_ HMO/PPO] standard_charge|[payer_FIRSTCARE HEALTH PLANS ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_FIRSTCARE HEALTH PLANS ]|[Plan_ HMO/PPO] standard_charge|[payer_FIRSTCARE MCD STAR/CHIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_FIRSTCARE MCD STAR/CHIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_FIRSTCARE MCD STAR/CHIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_FIRSTCARE MCD STAR/CHIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_FIRSTCARE MCD STAR/CHIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_FIRSTCARE MCD STAR/CHIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_FIRSTCARE MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_FIRSTCARE MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_FIRSTCARE MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_FIRSTCARE MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_FIRSTCARE MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_FIRSTCARE MCR ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_GEHA ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_GEHA ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_GEHA ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GEHA ]|[plan_ COMMERCIAL] standard_charge|[payer_GEHA ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_GEHA ]|[Plan_ COMMERCIAL] standard_charge|[payer_HEALTH SMART ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH SMART ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTH SMART ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTH SMART ]|[plan_ HMO/PPO] standard_charge|[payer_HEALTH SMART ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HEALTH SMART ]|[Plan_ HMO/PPO] standard_charge|[payer_HI DEPT OF HEALTH ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_HI DEPT OF HEALTH ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_HI DEPT OF HEALTH ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_HI DEPT OF HEALTH ]|[plan_ LOCAL GOVT] standard_charge|[payer_HI DEPT OF HEALTH ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_HI DEPT OF HEALTH ]|[Plan_ LOCAL GOVT] standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA BEHAVIORAL HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_HUMANA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MCR ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MCR ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_ICE HEALTH SERVICE CORPS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ICE HEALTH SERVICE CORPS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ICE HEALTH SERVICE CORPS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ICE HEALTH SERVICE CORPS ]|[plan_ LOCAL GOVT] standard_charge|[payer_ICE HEALTH SERVICE CORPS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_ICE HEALTH SERVICE CORPS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_ID DHW ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ID DHW ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ID DHW ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ID DHW ]|[plan_ LOCAL GOVT] standard_charge|[payer_ID DHW ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_ID DHW ]|[Plan_ LOCAL GOVT] standard_charge|[payer_INTEGRATED BEHAVIORAL HEA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_INTEGRATED BEHAVIORAL HEA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_INTEGRATED BEHAVIORAL HEA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_INTEGRATED BEHAVIORAL HEA ]|[plan_ HMO/PPO] standard_charge|[payer_INTEGRATED BEHAVIORAL HEA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_INTEGRATED BEHAVIORAL HEA ]|[Plan_ HMO/PPO] standard_charge|[payer_MAGELLAN BCBS MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MAGELLAN BCBS MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MAGELLAN BCBS MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MAGELLAN BCBS MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MAGELLAN BCBS MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MAGELLAN BCBS MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MAGELLAN HMO/PPO ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN HMO/PPO ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN HMO/PPO ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN HMO/PPO ]|[plan_ HMO/PPO] standard_charge|[payer_MAGELLAN HMO/PPO ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN HMO/PPO ]|[Plan_ HMO/PPO] standard_charge|[payer_MAGELLAN STAR CHIP MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MAGELLAN STAR CHIP MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MAGELLAN STAR CHIP MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MAGELLAN STAR CHIP MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MAGELLAN STAR CHIP MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MAGELLAN STAR CHIP MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MANAGED HEALTH NETWORK ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MANAGED HEALTH NETWORK ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MANAGED HEALTH NETWORK ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MANAGED HEALTH NETWORK ]|[plan_ HMO/PPO] standard_charge|[payer_MANAGED HEALTH NETWORK ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MANAGED HEALTH NETWORK ]|[Plan_ HMO/PPO] standard_charge|[payer_MEDICAID ]|[plan_ MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID ]|[plan_ MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID ]|[plan_ MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID ]|[plan_ MEDICAID ] standard_charge|[payer_MEDICAID ]|[plan_ MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID ]|[Plan_ MEDICAID ] standard_charge|[payer_MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_MEDICAID OUT OF STATE ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE ]|[plan_ MEDICARE] standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE ]|[Plan_ MEDICARE] standard_charge|[payer_MERCY CARE ARIZONA MCD ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MERCY CARE ARIZONA MCD ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MERCY CARE ARIZONA MCD ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MERCY CARE ARIZONA MCD ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MERCY CARE ARIZONA MCD ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MERCY CARE ARIZONA MCD ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MERCY CARE RBHA ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MERCY CARE RBHA ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MERCY CARE RBHA ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MERCY CARE RBHA ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MERCY CARE RBHA ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MERCY CARE RBHA ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MGD MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MGD MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_MGD MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_MGD MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_MGD MEDICAID OUT OF STATE ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_MGD MEDICAID OUT OF STATE ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_MHMR BRAZOS VALLEY ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MHMR BRAZOS VALLEY ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MHMR BRAZOS VALLEY ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MHMR BRAZOS VALLEY ]|[plan_ LOCAL GOVT] standard_charge|[payer_MHMR BRAZOS VALLEY ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_MHMR BRAZOS VALLEY ]|[Plan_ LOCAL GOVT] standard_charge|[payer_MHMR BROWNWOOD ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MHMR BROWNWOOD ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MHMR BROWNWOOD ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MHMR BROWNWOOD ]|[plan_ LOCAL GOVT] standard_charge|[payer_MHMR BROWNWOOD ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_MHMR BROWNWOOD ]|[Plan_ LOCAL GOVT] standard_charge|[payer_MHMR CENTRAL COUNTIES ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MHMR CENTRAL COUNTIES ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MHMR CENTRAL COUNTIES ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MHMR CENTRAL COUNTIES ]|[plan_ LOCAL GOVT] standard_charge|[payer_MHMR CENTRAL COUNTIES ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_MHMR CENTRAL COUNTIES ]|[Plan_ LOCAL GOVT] standard_charge|[payer_MHMR HEART OF TEXAS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MHMR HEART OF TEXAS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MHMR HEART OF TEXAS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MHMR HEART OF TEXAS ]|[plan_ LOCAL GOVT] standard_charge|[payer_MHMR HEART OF TEXAS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_MHMR HEART OF TEXAS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_MHMR MISC ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MHMR MISC ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MHMR MISC ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MHMR MISC ]|[plan_ LOCAL GOVT] standard_charge|[payer_MHMR MISC ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_MHMR MISC ]|[Plan_ LOCAL GOVT] standard_charge|[payer_MHNET MENTAL HEALTH NETWK ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MHNET MENTAL HEALTH NETWK ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MHNET MENTAL HEALTH NETWK ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MHNET MENTAL HEALTH NETWK ]|[plan_ HMO/PPO] standard_charge|[payer_MHNET MENTAL HEALTH NETWK ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MHNET MENTAL HEALTH NETWK ]|[Plan_ HMO/PPO] standard_charge|[payer_MISC COMMERCIAL ACUTE ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL ACUTE ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC COMMERCIAL ACUTE ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL ACUTE ]|[plan_ COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL ACUTE ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_MISC COMMERCIAL ACUTE ]|[Plan_ COMMERCIAL] standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MISC MGD MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCR ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MGD MCR ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MGD MCR ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCR ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MISC MGD MCR ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MO DSS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MO DSS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MO DSS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MO DSS ]|[plan_ LOCAL GOVT] standard_charge|[payer_MO DSS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_MO DSS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_MOLINA HEALTHCARE ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA HEALTHCARE ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MUTUAL OF OMAHA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MUTUAL OF OMAHA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MUTUAL OF OMAHA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MUTUAL OF OMAHA ]|[plan_ HMO/PPO] standard_charge|[payer_MUTUAL OF OMAHA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MUTUAL OF OMAHA ]|[Plan_ HMO/PPO] standard_charge|[payer_OH CUYAHOGA COUNTY ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OH CUYAHOGA COUNTY ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_OH CUYAHOGA COUNTY ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_OH CUYAHOGA COUNTY ]|[plan_ LOCAL GOVT] standard_charge|[payer_OH CUYAHOGA COUNTY ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_OH CUYAHOGA COUNTY ]|[Plan_ LOCAL GOVT] standard_charge|[payer_OPTUM MEDICAID WASHINGTON ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OPTUM MEDICAID WASHINGTON ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OPTUM MEDICAID WASHINGTON ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OPTUM MEDICAID WASHINGTON ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM MEDICAID WASHINGTON ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OPTUM MEDICAID WASHINGTON ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM UBH COMMUN MCD CHIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM UBH COMMUN MCD CHIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM UBH COMMUN MCD CHIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM UBH COMMUN MCD CHIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM UBH COMMUN MCD CHIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM UBH COMMUN MCD CHIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM UBH STAR UHRIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM UBH STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM UBH STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM UBH STAR UHRIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM UBH STAR UHRIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM UBH STAR UHRIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM UBH STAR+PLUS UHRIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM UBH STAR+PLUS UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM UBH STAR+PLUS UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM UBH STAR+PLUS UHRIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM UBH STAR+PLUS UHRIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM UBH STAR+PLUS UHRIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM-MCR CARE IMPR PLUS ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM-MCR CARE IMPR PLUS ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_OPTUM-MCR CARE IMPR PLUS ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_OPTUM-MCR CARE IMPR PLUS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM-MCR CARE IMPR PLUS ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_OPTUM-MCR CARE IMPR PLUS ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM-UHC STAR+PLUS MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM-UHC STAR+PLUS MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM-UHC STAR+PLUS MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM-UHC STAR+PLUS MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM-UHC STAR+PLUS MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM-UHC STAR+PLUS MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_PHCS/MULTIPLAN ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_PHCS/MULTIPLAN ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_PHCS/MULTIPLAN ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PHCS/MULTIPLAN ]|[plan_ HMO/PPO] standard_charge|[payer_PHCS/MULTIPLAN ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_PHCS/MULTIPLAN ]|[Plan_ HMO/PPO] standard_charge|[payer_RAMSEY COUNTY DFPS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_RAMSEY COUNTY DFPS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_RAMSEY COUNTY DFPS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_RAMSEY COUNTY DFPS ]|[plan_ LOCAL GOVT] standard_charge|[payer_RAMSEY COUNTY DFPS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_RAMSEY COUNTY DFPS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_SCOTT WHITE HEALTH PLAN ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_SCOTT WHITE HEALTH PLAN ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_SCOTT WHITE HEALTH PLAN ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SCOTT WHITE HEALTH PLAN ]|[plan_ HMO/PPO] standard_charge|[payer_SCOTT WHITE HEALTH PLAN ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_SCOTT WHITE HEALTH PLAN ]|[Plan_ HMO/PPO] standard_charge|[payer_SETON CHIP DELL CHILDRENS ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SETON CHIP DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SETON CHIP DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SETON CHIP DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SETON CHIP DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SETON CHIP DELL CHILDRENS ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SETON HEALTH PLAN ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_SETON HEALTH PLAN ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_SETON HEALTH PLAN ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SETON HEALTH PLAN ]|[plan_ HMO/PPO] standard_charge|[payer_SETON HEALTH PLAN ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_SETON HEALTH PLAN ]|[Plan_ HMO/PPO] standard_charge|[payer_SETON STAR DELL CHILDRENS ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SETON STAR DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SETON STAR DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SETON STAR DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SETON STAR DELL CHILDRENS ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SETON STAR DELL CHILDRENS ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SMART HEALTH ASCENSION ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_SMART HEALTH ASCENSION ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_SMART HEALTH ASCENSION ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_SMART HEALTH ASCENSION ]|[plan_ BLUE CROSS] standard_charge|[payer_SMART HEALTH ASCENSION ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_SMART HEALTH ASCENSION ]|[Plan_ BLUE CROSS] standard_charge|[payer_STEWARD HEALTH CHOICE ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_STEWARD HEALTH CHOICE ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_STEWARD HEALTH CHOICE ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_STEWARD HEALTH CHOICE ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_STEWARD HEALTH CHOICE ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_STEWARD HEALTH CHOICE ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_SUPERIOR FOSTER ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR FOSTER ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR FOSTER ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR FOSTER ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR FOSTER ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR FOSTER ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTH PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR HEALTH PLAN ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR HEALTH PLAN ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR HEALTH PLAN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTH PLAN ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR HEALTH PLAN ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR STAR UHRIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR STAR UHRIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR STAR UHRIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR STAR UHRIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SW RIGHTCARE STAR UHRIP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SW RIGHTCARE STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SW RIGHTCARE STAR UHRIP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SW RIGHTCARE STAR UHRIP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SW RIGHTCARE STAR UHRIP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SW RIGHTCARE STAR UHRIP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SW RIGHTCARE/VALENCE ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SW RIGHTCARE/VALENCE ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SW RIGHTCARE/VALENCE ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SW RIGHTCARE/VALENCE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SW RIGHTCARE/VALENCE ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SW RIGHTCARE/VALENCE ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SWHP SENIOR CARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SWHP SENIOR CARE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SWHP SENIOR CARE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SWHP SENIOR CARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_SWHP SENIOR CARE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SWHP SENIOR CARE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_TRI WEST REGION CLAIMS ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRI WEST REGION CLAIMS ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRI WEST REGION CLAIMS ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRI WEST REGION CLAIMS ]|[plan_ TRICARE] standard_charge|[payer_TRI WEST REGION CLAIMS ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRI WEST REGION CLAIMS ]|[Plan_ TRICARE] standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] standard_charge|[payer_TRICARE EAST REGION ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST REGION ]|[Plan_ TRICARE] standard_charge|[payer_TRICARE FOR LIFE ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE ]|[plan_ TRICARE] standard_charge|[payer_TRICARE FOR LIFE ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE FOR LIFE ]|[Plan_ TRICARE] standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] standard_charge|[payer_TRICARE OVERSEAS ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE OVERSEAS ]|[Plan_ TRICARE] standard_charge|[payer_TX BELONG TO BELONG ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TX BELONG TO BELONG ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_TX BELONG TO BELONG ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_TX BELONG TO BELONG ]|[plan_ LOCAL GOVT] standard_charge|[payer_TX BELONG TO BELONG ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_TX BELONG TO BELONG ]|[Plan_ LOCAL GOVT] standard_charge|[payer_TX DFPS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TX DFPS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_TX DFPS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_TX DFPS ]|[plan_ LOCAL GOVT] standard_charge|[payer_TX DFPS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_TX DFPS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_TX OCOK ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TX OCOK ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_TX OCOK ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_TX OCOK ]|[plan_ LOCAL GOVT] standard_charge|[payer_TX OCOK ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_TX OCOK ]|[Plan_ LOCAL GOVT] standard_charge|[payer_UBH MCR ADVANTAGE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UBH MCR ADVANTAGE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UBH MCR ADVANTAGE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UBH MCR ADVANTAGE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UBH MCR ADVANTAGE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UBH MCR ADVANTAGE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UBH/MCR CARE IMPROV PLUS ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UBH/MCR CARE IMPROV PLUS ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UBH/MCR CARE IMPROV PLUS ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UBH/MCR CARE IMPROV PLUS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UBH/MCR CARE IMPROV PLUS ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UBH/MCR CARE IMPROV PLUS ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH CARE ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTH CARE ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTH CARE ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH CARE ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH CARE ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTH CARE ]|[Plan_ HMO/PPO] standard_charge|[payer_USA MANAGED CARE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_USA MANAGED CARE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_USA MANAGED CARE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_USA MANAGED CARE]|[plan_ HMO/PPO] standard_charge|[payer_USA MANAGED CARE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_USA MANAGED CARE]|[Plan_ HMO/PPO] standard_charge|[payer_VA STAFFORD COUNTY ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_VA STAFFORD COUNTY ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_VA STAFFORD COUNTY ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_VA STAFFORD COUNTY ]|[plan_ LOCAL GOVT] standard_charge|[payer_VA STAFFORD COUNTY ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_VA STAFFORD COUNTY ]|[Plan_ LOCAL GOVT] standard_charge|[payer_VAPC3 ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_VAPC3 ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_VAPC3 ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_VAPC3 ]|[plan_ TRICARE] standard_charge|[payer_VAPC3 ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_VAPC3 ]|[Plan_ TRICARE] standard_charge|[payer_VAPC3 ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VAPC3 ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VAPC3 ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VAPC3 ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VAPC3 ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VAPC3 ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_WA COORDINATED CARE ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_WA COORDINATED CARE ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_WA COORDINATED CARE ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_WA COORDINATED CARE ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_WA COORDINATED CARE ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_WA COORDINATED CARE ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_WA MOLINA ]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_WA MOLINA ]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_WA MOLINA ]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_WA MOLINA ]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_WA MOLINA ]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_WA MOLINA ]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_WESTERN SKY COMMUNITY CAR ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_WESTERN SKY COMMUNITY CAR ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_WESTERN SKY COMMUNITY CAR ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_WESTERN SKY COMMUNITY CAR ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_WESTERN SKY COMMUNITY CAR ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_WESTERN SKY COMMUNITY CAR ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_WILLIAMSON COUNTY JUVENIL ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_WILLIAMSON COUNTY JUVENIL ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_WILLIAMSON COUNTY JUVENIL ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_WILLIAMSON COUNTY JUVENIL ]|[plan_ LOCAL GOVT] standard_charge|[payer_WILLIAMSON COUNTY JUVENIL ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_WILLIAMSON COUNTY JUVENIL ]|[Plan_ LOCAL GOVT] standard_charge|[payer_WINNEBAGO COUNTY ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_WINNEBAGO COUNTY ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_WINNEBAGO COUNTY ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_WINNEBAGO COUNTY ]|[plan_ LOCAL GOVT] standard_charge|[payer_WINNEBAGO COUNTY ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_WINNEBAGO COUNTY ]|[Plan_ LOCAL GOVT] additional_generic_notes ACUTE ADULT INPT 124 RC facility inpatient 2500 700 492.66 1500 908 per diem 803 per diem 700 per diem 550 per diem 842.3 per diem 814 per diem 595 per diem 753 per diem 842.3 per diem 753 per diem 805 per diem 529.59 per diem 529.59 per diem 529.59 per diem 731 per diem 600 per diem 492.66 per diem 600 per diem 625 per diem 529.59 per diem 842.3 per diem 650 per diem 650 per diem 842.3 per diem 740 per diem 760 per diem 794.39 per diem 859 per diem 810 per diem 815 per diem 550 per diem 529.59 per diem 842.3 per diem 600 per diem 495 per diem 860 per diem 842.3 per diem 842.3 per diem 645 per diem 842 per diem 842 per diem 842 per diem 529.59 per diem 525 per diem 842.3 per diem 525 per diem 600 per diem 600 per diem 675 per diem 625 per diem 600 per diem 628 per diem 1500 per diem 529.59 per diem 842.3 per diem 650 per diem 600 per diem 529.59 per diem 783.8 per diem 783.8 per diem 842.3 per diem 529.59 per diem 650 per diem 700 per diem 550 per diem 600 per diem 550 per diem 600 per diem 500 per diem 668 per diem 668 per diem 988.64 per diem 783.8 per diem 529.59 per diem 880.71 per diem 928.06 per diem 880.71 per diem 823.98 per diem 794 per diem 842.3 per diem 842.3 per diem 840 per diem 665 per diem 842.3 per diem 1062.6 per diem ACUTE CHILD & ADOL 124 RC facility inpatient 2500 700 492.66 1500 908 per diem 803 per diem 700 per diem 550 per diem 814 per diem 595 per diem 753 per diem 753 per diem 805 per diem 529.59 per diem 529.59 per diem 529.59 per diem 731 per diem 600 per diem 492.66 per diem 600 per diem 625 per diem 529.59 per diem 842.3 per diem 650 per diem 650 per diem 842.3 per diem 740 per diem 760 per diem 794.39 per diem 859 per diem 810 per diem 815 per diem 550 per diem 529.59 per diem 842.3 per diem 600 per diem 495 per diem 860 per diem 842.3 per diem 842.3 per diem 645 per diem 842 per diem 842 per diem 842 per diem 529.59 per diem 525 per diem 842.3 per diem 525 per diem 600 per diem 600 per diem 675 per diem 625 per diem 600 per diem 628 per diem 1500 per diem 529.59 per diem 842.3 per diem 650 per diem 600 per diem 529.59 per diem 783.8 per diem 783.8 per diem 842.3 per diem 529.59 per diem 650 per diem 700 per diem 550 per diem 600 per diem 550 per diem 600 per diem 500 per diem 668 per diem 668 per diem 988.64 per diem 783.8 per diem 529.59 per diem 880.71 per diem 928.06 per diem 880.71 per diem 823.98 per diem 794 per diem 842.3 per diem 842.3 per diem 840 per diem 665 per diem 842.3 per diem 1062.6 per diem ACUTE AD&GERO CD DET 126 RC facility inpatient 2500 492.66 1500 908 per diem 803 per diem 700 per diem 550 per diem 814 per diem 595 per diem 753 per diem 753 per diem 805 per diem 529.59 per diem 529.59 per diem 529.59 per diem 731 per diem 600 per diem 492.66 per diem 600 per diem 625 per diem 529.59 per diem 650 per diem 650 per diem 842.3 per diem 794.39 per diem 859 per diem 810 per diem 815 per diem 550 per diem 529.59 per diem 842.3 per diem 600 per diem 495 per diem 860 per diem 842.3 per diem 842.3 per diem 600 per diem 842 per diem 842 per diem 842 per diem 529.59 per diem 842.3 per diem 1500 per diem 529.59 per diem 783.8 per diem 783.8 per diem 842.3 per diem 529.59 per diem 650 per diem 700 per diem 550 per diem 600 per diem 550 per diem 600 per diem 668 per diem 668 per diem 988.64 per diem 783.8 per diem 529.59 per diem 880.71 per diem 928.06 per diem 880.71 per diem 823.98 per diem 794 per diem 842.3 per diem 842.3 per diem 840 per diem 665 per diem 842.3 per diem ACUTE ADOL CD DETOX 126 RC facility inpatient 2500 492.66 1500 908 per diem 803 per diem 700 per diem 550 per diem 595 per diem 753 per diem 753 per diem 805 per diem 529.59 per diem 529.59 per diem 529.59 per diem 731 per diem 600 per diem 492.66 per diem 600 per diem 625 per diem 529.59 per diem 650 per diem 650 per diem 842.3 per diem 794.39 per diem 859 per diem 810 per diem 815 per diem 550 per diem 529.59 per diem 842.3 per diem 600 per diem 495 per diem 860 per diem 842.3 per diem 842.3 per diem 600 per diem 842 per diem 842 per diem 842 per diem 529.59 per diem 842.3 per diem 1500 per diem 529.59 per diem 783.8 per diem 783.8 per diem 842.3 per diem 529.59 per diem 650 per diem 700 per diem 550 per diem 600 per diem 550 per diem 600 per diem 668 per diem 668 per diem 988.64 per diem 783.8 per diem 529.59 per diem 880.71 per diem 928.06 per diem 880.71 per diem 823.98 per diem 794 per diem 842.3 per diem 842.3 per diem 840 per diem 665 per diem 842.3 per diem ACUTE ADOL CD REHAB 128 RC facility inpatient 2500 400 1500 908 per diem 803 per diem 680 per diem 550 per diem 529.59 per diem 529.59 per diem 529.59 per diem 731 per diem 600 per diem 492.66 per diem 600 per diem 625 per diem 650 per diem 650 per diem 842.3 per diem 740 per diem 794.39 per diem 859 per diem 810 per diem 815 per diem 400 per diem 529.59 per diem 842.3 per diem 600 per diem 495 per diem 610 per diem 842.3 per diem 842.3 per diem 600 per diem 842 per diem 842 per diem 842 per diem 529.59 per diem 842.3 per diem 628 per diem 1500 per diem 490 per diem 700 per diem 880.71 per diem 928.06 per diem 880.71 per diem 842.3 per diem BRIDGE ON DC AME ADO 513 RC facility inpatient 80 102.86 121 per diem 121.3 per diem 102.86 per diem BRIDGE ON DC TRI ADO 513 RC facility inpatient 121.3 102.86 121 121.3 per diem 102.86 per diem INTENSIVE OP ADOLESC 905 RC facility outpatient 625 225 125 2000 211 per diem 187 per diem 150 per diem 170 per diem 228 per diem 228 per diem 240 per diem 150 per diem 150 per diem 156 per diem 150 per diem 2000 per diem 150 per diem 150 per diem 150 per diem 194.1 per diem 275 per diem 190 per diem 189 per diem 125 per diem 170 per diem 194.1 per diem 231 per diem 231 per diem 231 per diem 137 per diem 194.1 per diem 139 per diem 150 per diem 145 per diem 145 per diem 150 per diem 150 per diem 150 per diem 140 per diem 150 per diem 150 per diem 175.71 per diem 175.71 per diem 145 per diem 145 per diem 153 per diem INTENSIVE OUTPATIENT PROGRAM MH ADULT 905 RC facility outpatient 625 225 125 2000 211 per diem 187 per diem 150 per diem 170 per diem 228 per diem 228 per diem 240 per diem 150 per diem 150 per diem 156 per diem 150 per diem 2000 per diem 150 per diem 150 per diem 150 per diem 194.1 per diem 275 per diem 190 per diem 189 per diem 125 per diem 170 per diem 194.1 per diem 231 per diem 231 per diem 231 per diem 137 per diem 194.1 per diem 139 per diem 150 per diem 145 per diem 145 per diem 150 per diem 150 per diem 150 per diem 140 per diem 150 per diem 150 per diem 175.71 per diem 175.71 per diem 145 per diem 145 per diem 153 per diem TELE INTENSIVE OUTPATIENT PROGRAM ADOL PSYCH 905 RC facility outpatient 625 225 125 2000 211 per diem 187 per diem 150 per diem 170 per diem 228 per diem 228 per diem 240 per diem 150 per diem 150 per diem 156 per diem 150 per diem 2000 per diem 150 per diem 150 per diem 150 per diem 194.1 per diem 275 per diem 190 per diem 189 per diem 125 per diem 170 per diem 194.1 per diem 231 per diem 231 per diem 231 per diem 137 per diem 194.1 per diem 139 per diem 150 per diem 145 per diem 145 per diem 150 per diem 150 per diem 150 per diem 140 per diem 150 per diem 150 per diem 175.71 per diem 175.71 per diem 145 per diem 145 per diem 153 per diem TELE INTENSIVE OUTPATIENT PROGRAM ADULT MH 905 RC facility outpatient 625 225 125 2000 211 per diem 187 per diem 150 per diem 170 per diem 228 per diem 228 per diem 240 per diem 150 per diem 150 per diem 156 per diem 150 per diem 2000 per diem 150 per diem 150 per diem 150 per diem 194.1 per diem 275 per diem 190 per diem 189 per diem 125 per diem 170 per diem 194.1 per diem 231 per diem 231 per diem 231 per diem 137 per diem 194.1 per diem 139 per diem 150 per diem 145 per diem 145 per diem 150 per diem 150 per diem 150 per diem 140 per diem 150 per diem 150 per diem 175.71 per diem 175.71 per diem 145 per diem 145 per diem 153 per diem INTENSIVE OP CD ADUL 906 RC facility outpatient 625 225 125 2000 211 per diem 187 per diem 150 per diem 170 per diem 228 per diem 228 per diem 281 per diem 150 per diem 150 per diem 156 per diem 150 per diem 2000 per diem 150 per diem 150 per diem 150 per diem 194.1 per diem 275 per diem 190 per diem 189 per diem 125 per diem 170 per diem 194.1 per diem 231 per diem 231 per diem 231 per diem 137 per diem 194.1 per diem 139 per diem 150 per diem 145 per diem 145 per diem 150 per diem 150 per diem 150 per diem 140 per diem 150 per diem 150 per diem 145 per diem 145 per diem 153 per diem PARTIAL HOSPITAL PROGRAM HALF DAY ADOL 912 RC facility outpatient 625 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem PARTIAL HOSPITAL PROGRAM HALF MH ADULT 912 RC facility outpatient 825 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem PARTIAL HOSPITAL PROGRAM MH ADULT 912 RC facility outpatient 825 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem PARTIAL HOSPITAL PROGRAM TRIC ADOL PROC2 912 RC facility outpatient 225 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem TELE ADULT CD PARTIAL HOSPITAL PROGRAM 912 RC facility outpatient 825 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem TELE PARTIAL HOSPITAL PROGRAM ADOL PSYCH 912 RC facility outpatient 825 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem TELE PARTIAL HOSPITAL PROGRAM ADULT MH 912 RC facility outpatient 825 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem TRI PARTIAL HOSPITAL PROGRAM ADOL PROC 1 912 RC facility outpatient 225 225 135 454 454 per diem 150 per diem 212 per diem 267 per diem 267 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 340 per diem 189 per diem 225 per diem 355 per diem 194.1 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 175 per diem 165 per diem 275 per diem 275 per diem 135 per diem 275 per diem 250 per diem 267 per diem 275 per diem 194.1 per diem 246.56 per diem 257.29 per diem 200.06 per diem 200.06 per diem 145 per diem 153 per diem 246.56 per diem PARTIAL HOSPITAL PROGRAM ADOL PSYCH 913 RC facility outpatient 825 350 200.06 550 454 per diem 402 per diem 275 per diem 297 per diem 428 per diem 428 per diem 450 per diem 275 per diem 275 per diem 286 per diem 275 per diem 275 per diem 225 per diem 225 per diem 216.79 per diem 550 per diem 340 per diem 396 per diem 225 per diem 355 per diem 216.79 per diem 225 per diem 356 per diem 356 per diem 356 per diem 252 per diem 216.19 per diem 309 per diem 350 per diem 275 per diem 310 per diem 310 per diem 330 per diem 275 per diem 280 per diem 275 per diem 250 per diem 267 per diem 216.79 per diem 330.29 per diem 257.29 per diem 200.06 per diem 200.06 per diem 310 per diem 310 per diem 330 per diem 330.29 per diem GROUP THER 45-50 915 RC facility outpatient 225 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem INTENSIVE OUTPATIENT PROGRAM MCR ADUL PROC 2 915 RC facility outpatient 220 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem INTENSIVE OUTPATIENT PROGRAM MCR PROC GRP 1 915 RC facility outpatient 220 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem INTENSIVE OUTPATIENT PROGRAM MCR TH PROCESS 2 915 RC facility outpatient 250 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem OP PROCESS GROUP TX 915 RC facility outpatient 160 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem PARTIAL HOSPITAL PROGRAM MCR TH PROC GRP1 915 RC facility outpatient 225 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem PARTIAL HOSPITAL PROGRAM PROCESS GROUP 1 915 RC facility outpatient 225 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem PROCESS GOALS GROUP 915 RC facility outpatient 90 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem PROCESS GROUP 915 RC facility outpatient 160 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem TH PARTIAL HOSPITAL PROGRAM CD MCR PRC 1 915 RC facility outpatient 325 275 200.06 402 402 per diem 216.19 per diem 275 per diem 257.29 per diem 200.06 per diem FAMILY THER W/PT 916 RC facility outpatient 160 402 402 402 per diem RESIDENTIAL TREATMENT CENTER ADOL <17 UNIT 1 1001 RC facility inpatient 1600 330 1500 606 per diem 500 per diem 550 per diem 500 per diem 550 per diem 650 per diem 425 per diem 494 per diem 494 per diem 520 per diem 450 per diem 450 per diem 450 per diem 468 per diem 350 per diem 450 per diem 750 per diem 750 per diem 765 per diem 862.95 per diem 787.95 per diem 600 per diem 550 per diem 450 per diem 450 per diem 537 per diem 540 per diem 898.66 per diem 794.39 per diem 635 per diem 400 per diem 440 per diem 340 per diem 502 per diem 610 per diem 650 per diem 415 per diem 605 per diem 605 per diem 605 per diem 461.79 per diem 461.79 per diem 445 per diem 1500 per diem 750 per diem 450 per diem 650 per diem 600 per diem 515 per diem 515 per diem 480 per diem 725 per diem 500 per diem 330 per diem 550 per diem 330 per diem 550 per diem 416 per diem 416 per diem 985.88 per diem 935.58 per diem 841 per diem 898.66 per diem 898.66 per diem 898.66 per diem 548 per diem 548 per diem 530 per diem 721 per diem 500 per diem 600 per diem 475 per diem 410 per diem 750 per diem RESIDENTIAL TREATMENT CENTER SUBACUTE CD 1002 RC facility inpatient 1500 330 986 606 per diem 500 per diem 550 per diem 500 per diem 550 per diem 650 per diem 425 per diem 494 per diem 494 per diem 520 per diem 450 per diem 450 per diem 450 per diem 468 per diem 350 per diem 450 per diem 750 per diem 750 per diem 765 per diem 862.95 per diem 787.95 per diem 600 per diem 450 per diem 450 per diem 537 per diem 540 per diem 635 per diem 400 per diem 440 per diem 340 per diem 502 per diem 610 per diem 415 per diem 605 per diem 605 per diem 605 per diem 515 per diem 515 per diem 480 per diem 330 per diem 550 per diem 330 per diem 416 per diem 416 per diem 985.88 per diem 935.58 per diem 841 per diem 548 per diem 548 per diem 530 per diem RESIDENTIAL TREATMENT CENTER SUBACUTE CD REHA 1002 RC facility inpatient 1500 330 986 606 per diem 500 per diem 550 per diem 500 per diem 550 per diem 650 per diem 425 per diem 494 per diem 494 per diem 520 per diem 450 per diem 450 per diem 450 per diem 468 per diem 350 per diem 450 per diem 750 per diem 750 per diem 765 per diem 862.95 per diem 787.95 per diem 600 per diem 450 per diem 450 per diem 537 per diem 540 per diem 635 per diem 400 per diem 440 per diem 340 per diem 502 per diem 610 per diem 415 per diem 605 per diem 605 per diem 605 per diem 515 per diem 515 per diem 480 per diem 330 per diem 550 per diem 330 per diem 416 per diem 416 per diem 985.88 per diem 935.58 per diem 841 per diem 548 per diem 548 per diem 530 per diem