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." "Greenbrier Hospital, LLC" 5/31/2024 2.0.0 "Covington, Louisiana" 200 Greenbriar Boulevard license_ 691 | 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 BETTER HEALTH ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AETNA BETTER HEALTH ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_AETNA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AL ELMORE COUNTY DHR ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_AL ELMORE COUNTY DHR ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_AL ELMORE COUNTY DHR ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AL ELMORE COUNTY DHR ]|[plan_ COMMERCIAL] standard_charge|[payer_AL ELMORE COUNTY DHR ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_AL ELMORE COUNTY DHR ]|[Plan_ COMMERCIAL] standard_charge|[payer_ALL SAVERS ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_ALL SAVERS ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_ALL SAVERS ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALL SAVERS ]|[plan_ HMO/PPO] standard_charge|[payer_ALL SAVERS ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_ALL SAVERS ]|[Plan_ HMO/PPO] standard_charge|[payer_ALLWELL BY LOUISIANA HEAL ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALLWELL BY LOUISIANA HEAL ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALLWELL BY LOUISIANA HEAL ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALLWELL BY LOUISIANA HEAL ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_ALLWELL BY LOUISIANA HEAL ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ALLWELL BY LOUISIANA HEAL ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AMBETTER ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_AMBETTER ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMBETTER ]|[plan_ HMO/PPO] standard_charge|[payer_AMBETTER ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_AMBETTER ]|[Plan_ HMO/PPO] standard_charge|[payer_AMERIHEALTH CARITAS ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIHEALTH CARITAS ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIHEALTH CARITAS ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIHEALTH CARITAS ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIHEALTH CARITAS ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BCBS FEDERAL ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS FEDERAL ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS FEDERAL ]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BCBS MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BCBS MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BCBS MEDICARE ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS OF LOUISIANA ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF LOUISIANA ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OF LOUISIANA ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OF LOUISIANA ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS OF LOUISIANA ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OF LOUISIANA ]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE ]|[Plan_ BLUE CROSS] 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_CHAMP VA ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] standard_charge|[payer_CHAMP VA ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMP VA ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_CIGNA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA ]|[plan_ HMO/PPO] standard_charge|[payer_CIGNA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA ]|[Plan_ HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA BEHAVIORAL ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA BEHAVIORAL ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA BEHAVIORAL ]|[plan_ HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA BEHAVIORAL ]|[Plan_ HMO/PPO] standard_charge|[payer_COMMUNITY CARE HEALTH ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_COMMUNITY CARE HEALTH ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_COMMUNITY CARE HEALTH ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_COMMUNITY CARE HEALTH ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_COMMUNITY CARE HEALTH ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_COMMUNITY CARE HEALTH ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_COVENTRY MHNET ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_COVENTRY MHNET ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_COVENTRY MHNET ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_COVENTRY MHNET ]|[plan_ COMMERCIAL] standard_charge|[payer_COVENTRY MHNET ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_COVENTRY MHNET ]|[Plan_ COMMERCIAL] standard_charge|[payer_DCFS ]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DCFS ]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DCFS ]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DCFS ]|[plan_ LOCAL GOVT] standard_charge|[payer_DCFS ]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_DCFS ]|[Plan_ LOCAL GOVT] standard_charge|[payer_ENTRUST ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_ENTRUST ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_ENTRUST ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ENTRUST ]|[plan_ COMMERCIAL] standard_charge|[payer_ENTRUST ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_ENTRUST ]|[Plan_ COMMERCIAL] standard_charge|[payer_GEHA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_GEHA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_GEHA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GEHA ]|[plan_ HMO/PPO] standard_charge|[payer_GEHA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_GEHA ]|[Plan_ HMO/PPO] standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GILSBAR ]|[plan_ HMO/PPO] standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_GILSBAR ]|[Plan_ HMO/PPO] standard_charge|[payer_GULF GUARANTY ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_GULF GUARANTY ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_GULF GUARANTY ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GULF GUARANTY ]|[plan_ COMMERCIAL] standard_charge|[payer_GULF GUARANTY ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_GULF GUARANTY ]|[Plan_ COMMERCIAL] standard_charge|[payer_HEALTHY BLUE ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HEALTHY BLUE ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HEALTHY BLUE ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HEALTHY BLUE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HEALTHY BLUE ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HEALTHY BLUE DUAL ADVANTA ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HEALTHY BLUE DUAL ADVANTA ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA ]|[Plan_ HMO/PPO] standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA GOLD ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA HEALTHY HORIZONS ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HUMANA HEALTHY HORIZONS ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HUMANA HEALTHY HORIZONS ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HUMANA HEALTHY HORIZONS ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_HUMANA HEALTHY HORIZONS ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HUMANA HEALTHY HORIZONS ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_INLAND EMPIRE HEALTH]|[PLAN_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_INLAND EMPIRE HEALTH]|[PLAN_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_INLAND EMPIRE HEALTH]|[PLAN_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_INLAND EMPIRE HEALTH]|[PLAN_ MANAGED MEDICARE ]|negotiated_algorithm standard_charge|[payer_INLAND EMPIRE HEALTH]|[PLAN_ MANAGED MEDICARE]|methodology additional_payer_notes |[payer_INLAND EMPIRE HEALTH]|[PLAN_ MANAGED MEDICARE] standard_charge|[payer_LOUISIANA HEALTHCARE CONN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_LOUISIANA HEALTHCARE CONN ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_LOUISIANA HEALTHCARE CONN ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_LOUISIANA HEALTHCARE CONN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_LOUISIANA HEALTHCARE CONN ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_LOUISIANA HEALTHCARE CONN ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_LOUISIANA STATE MEDICAID ]|[plan_ MEDICAID ]|negotiated_dollar standard_charge|[payer_LOUISIANA STATE MEDICAID ]|[plan_ MEDICAID ] |negotiated_percentage standard_charge|[payer_LOUISIANA STATE MEDICAID ]|[plan_ MEDICAID ] |negotiated_algorithm estimated_amount|[payer_LOUISIANA STATE MEDICAID ]|[plan_ MEDICAID ] standard_charge|[payer_LOUISIANA STATE MEDICAID ]|[plan_ MEDICAID ] |methodology additional_payer_notes |[payer_LOUISIANA STATE MEDICAID ]|[Plan_ MEDICAID ] standard_charge|[payer_MAGELLAN ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN ]|[plan_ HMO/PPO] standard_charge|[payer_MAGELLAN ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN ]|[Plan_ HMO/PPO] standard_charge|[payer_MAGELLAN CSOC ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MAGELLAN CSOC ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MAGELLAN CSOC ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MAGELLAN CSOC ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MAGELLAN CSOC ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MAGELLAN CSOC ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MEDICAID PENDING ]|[plan_ PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_MEDICAID PENDING ]|[plan_ PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_MEDICAID PENDING ]|[plan_ PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDICAID PENDING ]|[plan_ PENDING MEDICAID] standard_charge|[payer_MEDICAID PENDING ]|[plan_ PENDING MEDICAID] |methodology additional_payer_notes |[payer_MEDICAID PENDING ]|[Plan_ PENDING MEDICAID] standard_charge|[payer_MEDICAID SECONDARY ]|[plan_ MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID SECONDARY ]|[plan_ MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID SECONDARY ]|[plan_ MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID SECONDARY ]|[plan_ MEDICAID ] standard_charge|[payer_MEDICAID SECONDARY ]|[plan_ MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID SECONDARY ]|[Plan_ MEDICAID ] standard_charge|[payer_MEDICAID UNISYS ]|[plan_ MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID UNISYS ]|[plan_ MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID UNISYS ]|[plan_ MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID UNISYS ]|[plan_ MEDICAID ] standard_charge|[payer_MEDICAID UNISYS ]|[plan_ MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID UNISYS ]|[Plan_ MEDICAID ] 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_MENTAL HEALTH NETWORK ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MENTAL HEALTH NETWORK ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MENTAL HEALTH NETWORK ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MENTAL HEALTH NETWORK ]|[plan_ HMO/PPO] standard_charge|[payer_MENTAL HEALTH NETWORK ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MENTAL HEALTH NETWORK ]|[Plan_ HMO/PPO] standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_MERITAIN HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MERITAIN HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_MISC COMMERCIAL ]|[Plan_ COMMERCIAL] standard_charge|[payer_MISC MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MISC MANAGED MEDICARE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MISSISSIPPI MEDICAID ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MISSISSIPPI MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MISSISSIPPI MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MISSISSIPPI MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MISSISSIPPI MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MISSISSIPPI MEDICAID ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MS MEDICAID MOLINA ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MS MEDICAID MOLINA ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MS MEDICAID MOLINA ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MS MEDICAID MOLINA ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MS MEDICAID MOLINA ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MS MEDICAID MOLINA ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_OCHSNER MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OCHSNER MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_OCHSNER MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_OCHSNER MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_OCHSNER MANAGED MEDICARE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_OCHSNER MANAGED MEDICARE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_OPTUM BH MEDICARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM BH MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_OPTUM BH MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_OPTUM BH MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM BH MEDICARE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_OPTUM BH MEDICARE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM BH MEDICARE 1500 ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM BH MEDICARE 1500 ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_OPTUM BH MEDICARE 1500 ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_OPTUM BH MEDICARE 1500 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM BH MEDICARE 1500 ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_OPTUM BH MEDICARE 1500 ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_OPTUM UHC COMMUNITY ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM UHC COMMUNITY ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM UHC COMMUNITY ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM UHC COMMUNITY ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_OPTUM UHC COMMUNITY ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM UHC COMMUNITY ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_PEOPLES HEALTH MANAGED ]|[plan_ MEDICARE]|negotiated_dollar standard_charge|[payer_PEOPLES HEALTH MANAGED ]|[plan_ MEDICARE] |negotiated_percentage standard_charge|[payer_PEOPLES HEALTH MANAGED ]|[plan_ MEDICARE] |negotiated_algorithm estimated_amount|[payer_PEOPLES HEALTH MANAGED ]|[plan_ MEDICARE] standard_charge|[payer_PEOPLES HEALTH MANAGED ]|[plan_ MEDICARE] |methodology additional_payer_notes |[payer_PEOPLES HEALTH MANAGED ]|[Plan_ MEDICARE] standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_PRIORITY HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_SUREST ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_SUREST ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_SUREST ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SUREST ]|[plan_ HMO/PPO] standard_charge|[payer_SUREST ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_SUREST ]|[Plan_ HMO/PPO] standard_charge|[payer_TRICARE EAST REGION CLAIM ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST REGION CLAIM ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST REGION CLAIM ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST REGION CLAIM ]|[plan_ TRICARE] standard_charge|[payer_TRICARE EAST REGION CLAIM ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST REGION CLAIM ]|[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 PRIME ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE PRIME ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE PRIME ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE PRIME ]|[plan_ TRICARE] standard_charge|[payer_TRICARE PRIME ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE PRIME ]|[Plan_ TRICARE] standard_charge|[payer_TRICAREWEST VAPC3 ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_TRICAREWEST VAPC3 ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_TRICAREWEST VAPC3 ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_TRICAREWEST VAPC3 ]|[plan_ VETERANS ADMIN] standard_charge|[payer_TRICAREWEST VAPC3 ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_TRICAREWEST VAPC3 ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_TRIWEST WEST REGION CLAIM ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRIWEST WEST REGION CLAIM ]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRIWEST WEST REGION CLAIM ]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRIWEST WEST REGION CLAIM ]|[plan_ TRICARE] standard_charge|[payer_TRIWEST WEST REGION CLAIM ]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRIWEST WEST REGION CLAIM ]|[Plan_ TRICARE] standard_charge|[payer_TRUSTMARK ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_TRUSTMARK ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_TRUSTMARK ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_TRUSTMARK ]|[plan_ HMO/PPO] standard_charge|[payer_TRUSTMARK ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_TRUSTMARK ]|[Plan_ HMO/PPO] standard_charge|[payer_UBH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UBH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UBH ]|[plan_ HMO/PPO] standard_charge|[payer_UBH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UBH ]|[Plan_ HMO/PPO] standard_charge|[payer_UHC]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC]|[plan_ HMO/PPO] standard_charge|[payer_UHC]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UHC]|[Plan_ HMO/PPO] standard_charge|[payer_UHC DUAL COMPLETE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UHC DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC DUAL COMPLETE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UMR ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR ]|[plan_ HMO/PPO] standard_charge|[payer_UMR ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UMR ]|[Plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH CARE STUDEN ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTH CARE STUDEN ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTH CARE STUDEN ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH CARE STUDEN ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH CARE STUDEN ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTH CARE STUDEN ]|[Plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH INTGRTD SER ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTH INTGRTD SER ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTH INTGRTD SER ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH INTGRTD SER ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH INTGRTD SER ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTH INTGRTD SER ]|[Plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTH SHARED SERV ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTH SHARED SERV ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH SHARED SERV ]|[plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTH SHARED SERV ]|[Plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTH WEST ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UNITED HEALTH WEST ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UNITED HEALTH WEST ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH WEST ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTH WEST ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UNITED HEALTH WEST ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE HMO SNP ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE HMO SNP ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE HMO SNP ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE HMO SNP ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE HMO SNP ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE HMO SNP ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA CCN OPTUM ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_VA FLORIDA ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA FLORIDA ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA FLORIDA ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA FLORIDA ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA FLORIDA ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA FLORIDA ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_VA TEXAS ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA TEXAS ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA TEXAS ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA TEXAS ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA TEXAS ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA TEXAS ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_VANTAGE HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_VANTAGE HEALTH ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_VANTAGE HEALTH ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_VANTAGE HEALTH ]|[Plan_ HMO/PPO] standard_charge|[payer_VANTAGE HEALTH PLAN ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH PLAN ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_VANTAGE HEALTH PLAN ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH PLAN ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_VANTAGE HEALTH PLAN ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_VANTAGE HEALTH PLAN ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_VETERANS AFFAIRS ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VETERANS AFFAIRS ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VETERANS AFFAIRS ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VETERANS AFFAIRS ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VETERANS AFFAIRS ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VETERANS AFFAIRS ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_VHA COMMUNITY CARE ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VHA COMMUNITY CARE ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VHA COMMUNITY CARE ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VHA COMMUNITY CARE ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VHA COMMUNITY CARE ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VHA COMMUNITY CARE ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_WEB TPA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_WEB TPA ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_WEB TPA ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_WEB TPA ]|[plan_ HMO/PPO] standard_charge|[payer_WEB TPA ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_WEB TPA ]|[Plan_ HMO/PPO] standard_charge|[payer_WELLCARE MEDICARE ADVANT ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE MEDICARE ADVANT ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE MEDICARE ADVANT ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE MEDICARE ADVANT ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_WELLCARE MEDICARE ADVANT ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE MEDICARE ADVANT ]|[Plan_ MANAGED MEDICARE] additional_generic_notes ROOM AND BOARD ADOLESCENT PSYCH 124 RC facility inpatient 2376 702 700 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem other drg other DRG 774.51 per diem 892.06 per diem other DRG 892.06 per diem 892.06 per diem 876 per diem other DRG 998 per diem 998 per diem other DRG 825 per diem 737.63 per diem other drg 824 per diem 700 per diem 800 per diem 792.95 per diem other DRG 900 per diem other drg 781.89 per diem other drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem other drg 825 per diem 1112 per diem 2376 per diem other drg other drg 737.63 per diem other drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem other DRG 1048.9 per diem other DRG other DRG 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem other psych drg other psych drg other psych drg 975 per diem other psych drg other psych drg other psych drg 825 per diem other psych drg ROOM AND BOARD PSYCH 124 RC facility inpatient 2376 702 700 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem other drg other DRG 774.51 per diem 892.06 per diem other DRG 892.06 per diem 892.06 per diem 876 per diem other DRG 998 per diem 998 per diem other DRG 825 per diem 737.63 per diem other drg 824 per diem 700 per diem 800 per diem 792.95 per diem other DRG 900 per diem other drg 781.89 per diem other drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem other drg 825 per diem 1112 per diem 2376 per diem other drg other drg 737.63 per diem other drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem other DRG 1048.9 per diem other DRG other DRG 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem other psych drg other psych drg other psych drg 975 per diem other psych drg other psych drg other psych drg 825 per diem other psych drg ROOM AND BOARD ADOLESCENT DETOX 126 RC facility inpatient 2376 702 675 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem other drg other DRG 774.51 per diem 892.06 per diem other DRG 892.06 per diem 892.06 per diem 876 per diem other DRG 998 per diem 998 per diem other DRG 825 per diem 737.63 per diem other drg 824 per diem 675 per diem 800 per diem 792.95 per diem other DRG 900 per diem other drg 781.89 per diem other drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem other drg 825 per diem 1112 per diem 2376 per diem other drg other drg 737.63 per diem other drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem other DRG 1048.9 per diem other DRG other DRG 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem other psych drg other psych drg other psych drg 975 per diem other psych drg other psych drg other psych drg 825 per diem other psych drg ROOM AND BOARD ADULT DETOX 126 RC facility inpatient 2376 702 675 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem other drg other DRG 774.51 per diem 892.06 per diem other DRG 892.06 per diem 892.06 per diem 876 per diem other DRG 998 per diem 998 per diem other DRG 825 per diem 737.63 per diem other drg 824 per diem 675 per diem 800 per diem 792.95 per diem other DRG 900 per diem other drg 781.89 per diem other drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem other drg 825 per diem 1112 per diem 2376 per diem other drg other drg 737.63 per diem other drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem other DRG 1048.9 per diem other DRG other DRG 1112 per diem 850 per diem 850 per diem 824 per diem 850 per diem 850 per diem 850 per diem 850 per diem 824 per diem other psych drg other psych drg other psych drg 975 per diem other psych drg other psych drg other psych drg 825 per diem other psych drg ROOM AND BOARD REHAB 128 RC facility inpatient 2376 702 650 2376 1112 per diem 774.51 per diem 1112 per diem 800 per diem 850 per diem other drg other DRG 774.51 per diem 892.06 per diem other DRG 892.06 per diem 892.06 per diem 876 per diem other DRG 998 per diem 998 per diem other DRG 825 per diem 737.63 per diem other drg 824 per diem 650 per diem 800 per diem 792.95 per diem other DRG other drg 781.89 per diem other drg 811.39 per diem 737.63 per diem 725 per diem 737.63 per diem 737.63 per diem 737.63 per diem 737.63 per diem other drg 825 per diem 1112 per diem 2376 per diem other drg other drg 737.63 per diem other drg 850 per diem 824 per diem 737.63 per diem 969 per diem 850 per diem 1172.3 per diem other DRG 1048.9 per diem other DRG other DRG 1112 per diem INTENSIVE OUTPATIENT PROGRAM 22 JDC 905 RC facility outpatient 648 216 144 250 144 per diem 168 per diem 180.2 per diem 170 per diem 175 per diem 180 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 250 per diem 180 per diem per diem INTENSIVE OUTPATIENT PROGRAM ADULT TELEMED 905 RC facility outpatient 648 216 144 254 254 per diem 175 per diem 254 per diem 175 per diem 240.4 per diem 240.4 per diem 240.4 per diem 180 per diem 238 per diem 238 per diem 225 per diem 225 per diem 144 per diem 168 per diem 180.2 per diem 170 per diem 175 per diem 180 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 250 per diem 180 per diem per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADOLESCENT 905 RC facility outpatient 648 216 144 254 254 per diem 175 per diem 254 per diem 175 per diem 240.4 per diem 240.4 per diem 240.4 per diem 180 per diem 238 per diem 238 per diem 225 per diem 225 per diem 144 per diem 168 per diem 180.2 per diem 170 per diem 175 per diem 180 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 245 per diem 250 per diem 180 per diem per diem INTENSIVE OUTPATIENT PROGRAM CD GROUP ADOLESCENT 906 RC facility outpatient 54 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CD GRP 1 MCD 906 RC facility outpatient 54 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CHEM DEP 906 RC facility outpatient 648 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem INTENSIVE OUTPATIENT PROGRAM CHEM DEP ADOLESCENT 906 RC facility outpatient 648 216 144 254 254 per diem 144 per diem 254 per diem 144 per diem 240.4 per diem 240.4 per diem 240.4 per diem 185 per diem 238 per diem 238 per diem 225 per diem 144 per diem 168 per diem 148.32 per diem 144 per diem 150 per diem 180 per diem 180 per diem 180 per diem 150 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 180 per diem 3 HOUR GROUP 915 RC facility outpatient 70 216 168 245 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 per diem 203.18 per diem 204.07 per diem 212.25 per diem GROUP THERAPY 22ND 915 RC facility outpatient 25 216 168 245 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 per diem 203.18 per diem 204.07 per diem 212.25 per diem INTENSIVE OUTPATIENT PROGRAM MCR/T GRP 2 COVI 915 RC facility outpatient 216 216 144 275 144 per diem 204.12 per diem 203.18 per diem 275 per diem 250 per diem 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 245 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 per diem 203.18 per diem 204.07 per diem 212.25 per diem INTENSIVE OUTPATIENT PROGRAM MCR/TRC GRP 1 CO 915 RC facility outpatient 216 216 144 275 144 per diem 204.12 per diem 203.18 per diem 275 per diem 250 per diem 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 245 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 per diem 203.18 per diem 204.07 per diem 212.25 per diem INTENSIVE OUTPATIENT PROGRAM MCR/TRI GRP 3 CV 915 RC facility outpatient 216 216 144 275 144 per diem 204.12 per diem 203.18 per diem 275 per diem 250 per diem 168 per diem 204.12 per diem 204.12 per diem 180 per diem 204.12 per diem 204.12 per diem 245 per diem 202.17 per diem 206.47 per diem 206.47 per diem 245 per diem 245 per diem 204.07 per diem 203.18 per diem 204.07 per diem 212.25 per diem Initial Eval With Medical 90792 RC facility inpatient 310 75 144.43 75.86 fee schedule Rates based on patient diagnose 141.54 fee schedule Rates based on patient diagnose 75 fee schedule Rates based on patient diagnose 144.43 fee schedule Rates based on patient diagnose per diem Initial Hospital Care (50 Min) 99222 RC facility inpatient 210 87.95 136.07 136.07 fee schedule Rates based on patient diagnose 87.95 fee schedule Rates based on patient diagnose 87.95 fee schedule Rates based on patient diagnose 124.67 fee schedule Rates based on patient diagnose 99.73 per diem Rates based on patient diagnose 130.47 other Rates based on patient diagnose 130.47 other Rates based on patient diagnose 127.21 fee schedule Rates based on patient diagnose 124.67 other Rates based on patient diagnose Subseq Care (15 Min) 99231 RC facility inpatient 120 26.6 74.16 74.16 fee schedule Rates based on patient diagnose 26.6 fee schedule Rates based on patient diagnose 26.6 fee schedule Rates based on patient diagnose 49.81 fee schedule Rates based on patient diagnose 49.81 other Rates based on patient diagnose 49.81 other Rates based on patient diagnose Subseq Care (25 Min) 99232 RC facility inpatient 140 42.52 83.26 57.68 fee schedule Rates based on patient diagnose 42.52 fee schedule Rates based on patient diagnose 83.26 other Rates based on patient diagnose 76.34 other Rates based on patient diagnose 43.06 fee schedule Rates based on patient diagnose 71.91 other Rates based on patient diagnose 66.96 fee schedule Rates based on patient diagnose 52.6 per diem Rates based on patient diagnose 63.22 fee schedule Rates based on patient diagnose 77.23 fee schedule Rates based on patient diagnose 66.61 other Rates based on patient diagnose Subseq Care (35 Min) 99233 RC facility inpatient 200 54.85 196 54.85 fee schedule Rates based on patient diagnose 54.85 fee schedule Rates based on patient diagnose 77.44 per diem Rates based on patient diagnose 196 fee schedule Rates based on patient diagnose 98.78 fee schedule Rates based on patient diagnose Discharge Day Mgmt <30 Min 99238 RC facility inpatient 160 42.525 80.99 57.68 fee schedule Rates based on patient diagnose 42.53 fee schedule Rates based on patient diagnose 42.89 fee schedule Rates based on patient diagnose 65.18 other Rates based on patient diagnose 68.06 fee schedule Rates based on patient diagnose 56.75 per diem Rates based on patient diagnose 80.99 other Rates based on patient diagnose 80.99 other Rates based on patient diagnose 66.51 fee schedule Rates based on patient diagnose 65.18 other Rates based on patient diagnose