hospital_name last_updated_on version hospital_location hospital_address license_number|AR "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." "Riverview Behavioral Health, LLC" 5/31/2024 "2.0,0" "Texarkana, Arkansas" 701 Arkansas Boulevard license_ AR5046 | AR 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_ADVANTRA COVENTRY]|[plan_ MANAGED MEDICARE]|negotiated_dollar" "standard_charge|[payer_ADVANTRA COVENTRY]|[plan_ MANAGED MEDICARE] |negotiated_percentage" "standard_charge|[payer_ADVANTRA COVENTRY]|[plan_ MANAGED MEDICARE] |negotiated_algorithm" "estimated_amount|[payer_ADVANTRA COVENTRY]|[plan_ MANAGED MEDICARE] " "standard_charge|[payer_ADVANTRA COVENTRY]|[plan_ MANAGED MEDICARE] |methodology" "additional_payer_notes |[payer_ADVANTRA COVENTRY]|[Plan_ MANAGED MEDICARE]" "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO]|negotiated_dollar" "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO] |negotiated_percentage" "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO] |negotiated_algorithm" "estimated_amount|[payer_AETNA HMO PPO]|[plan_ HMO/PPO] " "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO] |methodology" "additional_payer_notes |[payer_AETNA HMO PPO]|[Plan_ HMO/PPO]" "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar" "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage" "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm" "estimated_amount|[payer_AETNA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] " "standard_charge|[payer_AETNA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |methodology" "additional_payer_notes |[payer_AETNA HMO PPO]|[Plan_ HMO/PPO PHYSICIAN]" "standard_charge|[payer_AETNA MEDICARE]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_AETNA MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_AETNA MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_AETNA MEDICARE]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_AETNA MEDICARE]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_AETNA MEDICARE]|[Plan_ MGD MEDICARE PHYS]" "standard_charge|[payer_AMBETTER]|[plan_ MANAGED MEDICAID]|negotiated_dollar" "standard_charge|[payer_AMBETTER]|[plan_ MANAGED MEDICAID] |negotiated_percentage" "standard_charge|[payer_AMBETTER]|[plan_ MANAGED MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_AMBETTER]|[plan_ MANAGED MEDICAID] " "standard_charge|[payer_AMBETTER]|[plan_ MANAGED MEDICAID] |methodology" "additional_payer_notes |[payer_AMBETTER]|[Plan_ MANAGED MEDICAID]" "standard_charge|[payer_AMBETTER]|[plan_ MGD MEDICAID PHYS]|negotiated_dollar" "standard_charge|[payer_AMBETTER]|[plan_ MGD MEDICAID PHYS] |negotiated_percentage" "standard_charge|[payer_AMBETTER]|[plan_ MGD MEDICAID PHYS] |negotiated_algorithm" "estimated_amount|[payer_AMBETTER]|[plan_ MGD MEDICAID PHYS] " "standard_charge|[payer_AMBETTER]|[plan_ MGD MEDICAID PHYS] |methodology" "additional_payer_notes |[payer_AMBETTER]|[Plan_ MGD MEDICAID PHYS]" "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ HMO/PPO]|negotiated_dollar" "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ HMO/PPO] |negotiated_percentage" "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ HMO/PPO] |negotiated_algorithm" "estimated_amount|[payer_AMBETTER PREMIUM]|[plan_ HMO/PPO] " "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ HMO/PPO] |methodology" "additional_payer_notes |[payer_AMBETTER PREMIUM]|[Plan_ HMO/PPO]" "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ MGD MEDICAID PHYS]|negotiated_dollar" "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ MGD MEDICAID PHYS] |negotiated_percentage" "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ MGD MEDICAID PHYS] |negotiated_algorithm" "estimated_amount|[payer_AMBETTER PREMIUM]|[plan_ MGD MEDICAID PHYS] " "standard_charge|[payer_AMBETTER PREMIUM]|[plan_ MGD MEDICAID PHYS] |methodology" "additional_payer_notes |[payer_AMBETTER PREMIUM]|[Plan_ MGD MEDICAID PHYS]" "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS]|negotiated_dollar" "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS] |negotiated_percentage" "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS] |negotiated_algorithm" "estimated_amount|[payer_AMERIBEN]|[plan_ BLUE CROSS] " "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS] |methodology" "additional_payer_notes |[payer_AMERIBEN]|[Plan_ BLUE CROSS]" "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS PHYSICIAN]|negotiated_dollar" "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_percentage" "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_algorithm" "estimated_amount|[payer_AMERIBEN]|[plan_ BLUE CROSS PHYSICIAN] " "standard_charge|[payer_AMERIBEN]|[plan_ BLUE CROSS PHYSICIAN] |methodology" "additional_payer_notes |[payer_AMERIBEN]|[Plan_ BLUE CROSS PHYSICIAN]" "standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar" "standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage" "standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] " "standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] |methodology" "additional_payer_notes |[payer_AMERIGROUP STAR]|[Plan_ MANAGED MEDICAID]" "standard_charge|[payer_AMERIGROUP TX MEDICARE]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_AMERIGROUP TX MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_AMERIGROUP TX MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_AMERIGROUP TX MEDICARE]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_AMERIGROUP TX MEDICARE]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_AMERIGROUP TX MEDICARE]|[Plan_ MGD MEDICARE PHYS]" "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_APC PASSE SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar" "standard_charge|[payer_APC PASSE SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage" "standard_charge|[payer_APC PASSE SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_APC PASSE SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] " "standard_charge|[payer_APC PASSE SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] |methodology" "additional_payer_notes |[payer_APC PASSE SUMMIT COMM CAR]|[Plan_ MANAGED MEDICAID]" "standard_charge|[payer_APC PASSE-SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar" "standard_charge|[payer_APC PASSE-SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage" "standard_charge|[payer_APC PASSE-SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_APC PASSE-SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] " "standard_charge|[payer_APC PASSE-SUMMIT COMM CAR]|[plan_ MANAGED MEDICAID] |methodology" "additional_payer_notes |[payer_APC PASSE-SUMMIT COMM CAR]|[Plan_ MANAGED MEDICAID]" "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MANAGED MEDICAID]|negotiated_dollar" "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MANAGED MEDICAID] |negotiated_percentage" "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_AR BCBS EXCHANGE]|[plan_ MANAGED MEDICAID] " "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MANAGED MEDICAID] |methodology" "additional_payer_notes |[payer_AR BCBS EXCHANGE]|[Plan_ MANAGED MEDICAID]" "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MGD MEDICAID PHYS]|negotiated_dollar" "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MGD MEDICAID PHYS] |negotiated_percentage" "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MGD MEDICAID PHYS] |negotiated_algorithm" "estimated_amount|[payer_AR BCBS EXCHANGE]|[plan_ MGD MEDICAID PHYS] " "standard_charge|[payer_AR BCBS EXCHANGE]|[plan_ MGD MEDICAID PHYS] |methodology" "additional_payer_notes |[payer_AR BCBS EXCHANGE]|[Plan_ MGD MEDICAID PHYS]" "standard_charge|[payer_AR BCBS MARKETPLACE]|[plan_ MANAGED MEDICAID]|negotiated_dollar" "standard_charge|[payer_AR BCBS MARKETPLACE]|[plan_ MANAGED MEDICAID] |negotiated_percentage" "standard_charge|[payer_AR BCBS MARKETPLACE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_AR BCBS MARKETPLACE]|[plan_ MANAGED MEDICAID] " "standard_charge|[payer_AR BCBS MARKETPLACE]|[plan_ MANAGED MEDICAID] |methodology" "additional_payer_notes |[payer_AR BCBS MARKETPLACE]|[Plan_ MANAGED MEDICAID]" "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO]|negotiated_dollar" "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO] |negotiated_percentage" "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO] |negotiated_algorithm" "estimated_amount|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO] " "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO] |methodology" "additional_payer_notes |[payer_AR HEALTH & WELLNESS]|[Plan_ HMO/PPO]" "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar" "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage" "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm" "estimated_amount|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO PHYSICIAN] " "standard_charge|[payer_AR HEALTH & WELLNESS]|[plan_ HMO/PPO PHYSICIAN] |methodology" "additional_payer_notes |[payer_AR HEALTH & WELLNESS]|[Plan_ HMO/PPO PHYSICIAN]" "standard_charge|[payer_AR HEALTH & WELLNESS MCR]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_AR HEALTH & WELLNESS MCR]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_AR HEALTH & WELLNESS MCR]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_AR HEALTH & WELLNESS MCR]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_AR HEALTH & WELLNESS MCR]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_AR HEALTH & WELLNESS MCR]|[Plan_ MGD MEDICARE PHYS]" "standard_charge|[payer_AR SUPERIOR SELECT INC]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_AR SUPERIOR SELECT INC]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_AR SUPERIOR SELECT INC]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_AR SUPERIOR SELECT INC]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_AR SUPERIOR SELECT INC]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_AR SUPERIOR SELECT INC]|[Plan_ MGD MEDICARE PHYS]" "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MANAGED MEDICARE]|negotiated_dollar" "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MANAGED MEDICARE] |negotiated_percentage" "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MANAGED MEDICARE] |negotiated_algorithm" "estimated_amount|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MANAGED MEDICARE] " "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MANAGED MEDICARE] |methodology" "additional_payer_notes |[payer_ARCADIAN HEALTH PLAN INC]|[Plan_ MANAGED MEDICARE]" "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_ARCADIAN HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_ARCADIAN HEALTH PLAN INC]|[Plan_ MGD MEDICARE PHYS]" "standard_charge|[payer_ARKANSAS ADULT MEDICAID]|[plan_ MEDICAID]|negotiated_dollar" "standard_charge|[payer_ARKANSAS ADULT MEDICAID]|[plan_ MEDICAID] |negotiated_percentage" "standard_charge|[payer_ARKANSAS ADULT MEDICAID]|[plan_ MEDICAID] |negotiated_algorithm" "estimated_amount|[payer_ARKANSAS ADULT MEDICAID]|[plan_ MEDICAID] " "standard_charge|[payer_ARKANSAS ADULT MEDICAID]|[plan_ MEDICAID] |methodology" "additional_payer_notes |[payer_ARKANSAS ADULT MEDICAID]|[Plan_ MEDICAID]" standard_charge|[payer_ARKANSAS MEDICAID]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_ARKANSAS MEDICAID]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_ARKANSAS MEDICAID]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_ARKANSAS MEDICAID]|[plan_ MEDICAID] standard_charge|[payer_ARKANSAS MEDICAID]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_ARKANSAS MEDICAID]|[Plan_ MEDICAID] standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ARKANSAS TOTAL CARE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ARKANSAS TOTAL CARE]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS ARKANSAS]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS PHYSICIAN]|negotiated_dollar standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_percentage standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS PHYSICIAN] standard_charge|[payer_BCBS ARKANSAS]|[plan_ BLUE CROSS PHYSICIAN] |methodology additional_payer_notes |[payer_BCBS ARKANSAS]|[Plan_ BLUE CROSS PHYSICIAN] 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 FEDERAL]|[plan_ BLUE CROSS PHYSICIAN]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS PHYSICIAN] standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS PHYSICIAN] |methodology additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_ BLUE CROSS PHYSICIAN] 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_BCBS OUT OF STATE]|[plan_ BLUE CROSS PHYSICIAN]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS PHYSICIAN] standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS PHYSICIAN] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE]|[Plan_ BLUE CROSS PHYSICIAN] standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARE IMPROVEMENT PLUS]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CARE IMPROVEMENT PLUS]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_CARE IMPROVEMENT PLUS]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_CARE IMPROVEMENT PLUS]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_CARESOURCE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CARESOURCE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CARESOURCE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CARESOURCE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_CARESOURCE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CARESOURCE]|[Plan_ MANAGED MEDICAID] "standard_charge|[payer_CHA HMO, INC]|[plan_ MANAGED MEDICARE]|negotiated_dollar" "standard_charge|[payer_CHA HMO, INC]|[plan_ MANAGED MEDICARE] |negotiated_percentage" "standard_charge|[payer_CHA HMO, INC]|[plan_ MANAGED MEDICARE] |negotiated_algorithm" "estimated_amount|[payer_CHA HMO, INC]|[plan_ MANAGED MEDICARE] " "standard_charge|[payer_CHA HMO, INC]|[plan_ MANAGED MEDICARE] |methodology" "additional_payer_notes |[payer_CHA HMO, INC]|[Plan_ MANAGED MEDICARE]" "standard_charge|[payer_CHA HMO, INC]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_CHA HMO, INC]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_CHA HMO, INC]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_CHA HMO, INC]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_CHA HMO, INC]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_CHA HMO, INC]|[Plan_ MGD MEDICARE PHYS]" standard_charge|[payer_CHARITY]|[plan_ SELF PAY CHARITY]|negotiated_dollar standard_charge|[payer_CHARITY]|[plan_ SELF PAY CHARITY] |negotiated_percentage standard_charge|[payer_CHARITY]|[plan_ SELF PAY CHARITY] |negotiated_algorithm estimated_amount|[payer_CHARITY]|[plan_ SELF PAY CHARITY] standard_charge|[payer_CHARITY]|[plan_ SELF PAY CHARITY] |methodology additional_payer_notes |[payer_CHARITY]|[Plan_ SELF PAY CHARITY] standard_charge|[payer_CHOCTAW NATION]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_CHOCTAW NATION]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_CHOCTAW NATION]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CHOCTAW NATION]|[plan_ COMMERCIAL] standard_charge|[payer_CHOCTAW NATION]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_CHOCTAW NATION]|[Plan_ COMMERCIAL] standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO] standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_CHRISTUS HEALTH PLAN]|[Plan_ HMO/PPO] standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_CHRISTUS HEALTH PLAN]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_CHRISTUS HEALTH PLAN]|[Plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_CIGNA HLSPRING - MEDICARE]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_CIGNA HLSPRING - MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_CIGNA HLSPRING - MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_CIGNA HLSPRING - MEDICARE]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_CIGNA HLSPRING - MEDICARE]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_CIGNA HLSPRING - MEDICARE]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_CIGNA HMO PPO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA HMO PPO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA HMO PPO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA HMO PPO]|[plan_ HMO/PPO] standard_charge|[payer_CIGNA HMO PPO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA HMO PPO]|[Plan_ HMO/PPO] 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_COVENTRY HEALTH AND LIFE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_COVENTRY HEALTH AND LIFE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_COVENTRY HEALTH AND LIFE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COVENTRY HEALTH AND LIFE]|[plan_ HMO/PPO] standard_charge|[payer_COVENTRY HEALTH AND LIFE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_COVENTRY HEALTH AND LIFE]|[Plan_ HMO/PPO] standard_charge|[payer_COVENTRY MEDICARE]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_COVENTRY MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_COVENTRY MEDICARE]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_COVENTRY MEDICARE]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_COVENTRY MEDICARE]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_COVENTRY MEDICARE]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_DELTA COUNCELLING ASSOC]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DELTA COUNCELLING ASSOC]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DELTA COUNCELLING ASSOC]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DELTA COUNCELLING ASSOC]|[plan_ LOCAL GOVT] standard_charge|[payer_DELTA COUNCELLING ASSOC]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_DELTA COUNCELLING ASSOC]|[Plan_ LOCAL GOVT] standard_charge|[payer_DHS ARKANSAS]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DHS ARKANSAS]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DHS ARKANSAS]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DHS ARKANSAS]|[plan_ LOCAL GOVT] standard_charge|[payer_DHS ARKANSAS]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_DHS ARKANSAS]|[Plan_ LOCAL GOVT] standard_charge|[payer_EMPOWER]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EMPOWER]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EMPOWER]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EMPOWER]|[plan_ MANAGED MEDICAID] standard_charge|[payer_EMPOWER]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EMPOWER]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI]|[plan_ MGD MEDICAID PHYS]|negotiated_dollar standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI]|[plan_ MGD MEDICAID PHYS] |negotiated_percentage standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI]|[plan_ MGD MEDICAID PHYS] |negotiated_algorithm estimated_amount|[payer_EMPOWER HEALTHCARE SOLUTI]|[plan_ MGD MEDICAID PHYS] standard_charge|[payer_EMPOWER HEALTHCARE SOLUTI]|[plan_ MGD MEDICAID PHYS] |methodology additional_payer_notes |[payer_EMPOWER HEALTHCARE SOLUTI]|[Plan_ MGD MEDICAID PHYS] 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_HARMONY HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_HARMONY HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_HARMONY HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_HARMONY HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_HARMONY HEALTH PLAN INC]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_HARMONY HEALTH PLAN INC]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_HCSC INS SERVICES CO]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_HCSC INS SERVICES CO]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_HCSC INS SERVICES CO]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_HCSC INS SERVICES CO]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_HCSC INS SERVICES CO]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_HCSC INS SERVICES CO]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHFIRST]|[plan_ HMO/PPO] standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHFIRST]|[Plan_ HMO/PPO] standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_HEALTHFIRST]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_HEALTHFIRST]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_HEALTHFIRST]|[Plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA HMO PPO]|[Plan_ HMO/PPO] standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_HUMANA HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_HUMANA HMO PPO]|[Plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE HMO PPO]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_HUMANA MEDICARE HMO PPO]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_HUMANA MEDICARE HMO PPO]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN HMO]|[plan_ HMO/PPO] standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN HMO]|[Plan_ HMO/PPO] standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_MAGELLAN HMO]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_MAGELLAN HMO]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_MAGELLAN HMO]|[Plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAILHANDLERS]|[plan_ HMO/PPO] standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MAILHANDLERS]|[Plan_ HMO/PPO] standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_MAILHANDLERS]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_MAILHANDLERS]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_MAILHANDLERS]|[Plan_ HMO/PPO PHYSICIAN] 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_MEDICARE]|[plan_ MEDICARE PHYSICIAN]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_ MEDICARE PHYSICIAN] |negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_ MEDICARE PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_ MEDICARE PHYSICIAN] standard_charge|[payer_MEDICARE]|[plan_ MEDICARE PHYSICIAN] |methodology additional_payer_notes |[payer_MEDICARE]|[Plan_ MEDICARE PHYSICIAN] 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_MN BLUE PLUS]|[plan_ MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MN BLUE PLUS]|[plan_ MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_MN BLUE PLUS]|[plan_ MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_MN BLUE PLUS]|[plan_ MEDICAID: CBS OOS] standard_charge|[payer_MN BLUE PLUS]|[plan_ MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_MN BLUE PLUS]|[Plan_ MEDICAID: CBS OOS] standard_charge|[payer_MOLINA]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MUNICIPAL HEALTH BENEFIT]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MUNICIPAL HEALTH BENEFIT]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MUNICIPAL HEALTH BENEFIT]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MUNICIPAL HEALTH BENEFIT]|[plan_ HMO/PPO] standard_charge|[payer_MUNICIPAL HEALTH BENEFIT]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MUNICIPAL HEALTH BENEFIT]|[Plan_ HMO/PPO] standard_charge|[payer_NEWHAVEN]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_NEWHAVEN]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_NEWHAVEN]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_NEWHAVEN]|[plan_ LOCAL GOVT] standard_charge|[payer_NEWHAVEN]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_NEWHAVEN]|[Plan_ LOCAL GOVT] standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OKLAHOMA MEDICAID]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OKLAHOMA MEDICAID]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_OUACHITA BEHAVIORAL HEALT]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OUACHITA BEHAVIORAL HEALT]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_OUACHITA BEHAVIORAL HEALT]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_OUACHITA BEHAVIORAL HEALT]|[plan_ LOCAL GOVT] standard_charge|[payer_OUACHITA BEHAVIORAL HEALT]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_OUACHITA BEHAVIORAL HEALT]|[Plan_ LOCAL GOVT] standard_charge|[payer_PENDING ARKANSAS MEDICAID]|[plan_ PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_PENDING ARKANSAS MEDICAID]|[plan_ PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_PENDING ARKANSAS MEDICAID]|[plan_ PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_PENDING ARKANSAS MEDICAID]|[plan_ PENDING MEDICAID] standard_charge|[payer_PENDING ARKANSAS MEDICAID]|[plan_ PENDING MEDICAID] |methodology additional_payer_notes |[payer_PENDING ARKANSAS MEDICAID]|[Plan_ PENDING MEDICAID] standard_charge|[payer_PENDING TEXAS MEDICAID]|[plan_ PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_PENDING TEXAS MEDICAID]|[plan_ PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_PENDING TEXAS MEDICAID]|[plan_ PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_PENDING TEXAS MEDICAID]|[plan_ PENDING MEDICAID] standard_charge|[payer_PENDING TEXAS MEDICAID]|[plan_ PENDING MEDICAID] |methodology additional_payer_notes |[payer_PENDING TEXAS MEDICAID]|[Plan_ PENDING MEDICAID] standard_charge|[payer_SUPERIOR CHIP]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR CHIP]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR CHIP]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR CHIP]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR CHIP]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR CHIP]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR CHIPS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR CHIPS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR CHIPS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR CHIPS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR CHIPS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR CHIPS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR FOSTER CARE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR FOSTER CARE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR FOSTER CARE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR FOSTER CARE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR FOSTER CARE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR FOSTER CARE]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR HEALTHPLAN]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR HEALTHPLAN]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR MANAGED MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SUPERIOR MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SUPERIOR MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SUPERIOR MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_SUPERIOR MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SUPERIOR MANAGED MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_SUPERIOR PREGNANT WOMEN]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR PREGNANT WOMEN]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR PREGNANT WOMEN]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR PREGNANT WOMEN]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR PREGNANT WOMEN]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR PREGNANT WOMEN]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SW ARK COUNSELING MNTL HE]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_SW ARK COUNSELING MNTL HE]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_SW ARK COUNSELING MNTL HE]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_SW ARK COUNSELING MNTL HE]|[plan_ LOCAL GOVT] standard_charge|[payer_SW ARK COUNSELING MNTL HE]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_SW ARK COUNSELING MNTL HE]|[Plan_ LOCAL GOVT] standard_charge|[payer_TEXAS ADULT MEDICAID]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_TEXAS ADULT MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_TEXAS ADULT MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_TEXAS ADULT MEDICAID]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS ADULT MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_TEXAS ADULT MEDICAID]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS CHILDREN'S HEALTH]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TEXAS CHILDREN'S HEALTH]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TEXAS CHILDREN'S HEALTH]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TEXAS CHILDREN'S HEALTH]|[plan_ MANAGED MEDICAID] standard_charge|[payer_TEXAS CHILDREN'S HEALTH]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TEXAS CHILDREN'S HEALTH]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_TEXAS MEDICAID]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_TEXAS MEDICAID]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS PREGNANT WOMEN]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_TEXAS PREGNANT WOMEN]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_TEXAS PREGNANT WOMEN]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_TEXAS PREGNANT WOMEN]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS PREGNANT WOMEN]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_TEXAS PREGNANT WOMEN]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST]|[plan_ TRICARE] standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST]|[Plan_ TRICARE] standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO] standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UHC ALL SAVERS]|[Plan_ HMO/PPO] standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_UHC ALL SAVERS]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_UHC ALL SAVERS]|[Plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_UHC SHARED SERVICES]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UHC SHARED SERVICES]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UHC SHARED SERVICES]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UHC SHARED SERVICES]|[plan_ COMMERCIAL] standard_charge|[payer_UHC SHARED SERVICES]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UHC SHARED SERVICES]|[Plan_ COMMERCIAL] standard_charge|[payer_UHC TX STAR KIDS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC TX STAR KIDS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC TX STAR KIDS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC TX STAR KIDS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UHC TX STAR KIDS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC TX STAR KIDS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_UHC TX STAR PLUS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC TX STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC TX STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC TX STAR PLUS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UHC TX STAR PLUS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC TX STAR PLUS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO] standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UMR UNITED MEDICAL RSRCS]|[Plan_ HMO/PPO] "standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar" "standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage" "standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm" "estimated_amount|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO PHYSICIAN] " "standard_charge|[payer_UMR UNITED MEDICAL RSRCS]|[plan_ HMO/PPO PHYSICIAN] |methodology" "additional_payer_notes |[payer_UMR UNITED MEDICAL RSRCS]|[Plan_ HMO/PPO PHYSICIAN]" "standard_charge|[payer_UNITED HC COMM MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar" "standard_charge|[payer_UNITED HC COMM MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage" "standard_charge|[payer_UNITED HC COMM MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm" "estimated_amount|[payer_UNITED HC COMM MEDICARE]|[plan_ MANAGED MEDICARE] " "standard_charge|[payer_UNITED HC COMM MEDICARE]|[plan_ MANAGED MEDICARE] |methodology" "additional_payer_notes |[payer_UNITED HC COMM MEDICARE]|[Plan_ MANAGED MEDICARE]" standard_charge|[payer_UNITED HC COMMUNITY]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UNITED HC COMMUNITY]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UNITED HC COMMUNITY]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UNITED HC COMMUNITY]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UNITED HC COMMUNITY]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UNITED HC COMMUNITY]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE HMO PPO]|[Plan_ HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_UNITED HEALTHCARE HMO PPO]|[plan_ HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE HMO PPO]|[Plan_ HMO/PPO PHYSICIAN] standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE MDCR]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE MDCR]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE MDCR]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_UNITED HEALTHCARE MDCR]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE MDCR]|[Plan_ MGD MEDICARE PHYS] standard_charge|[payer_USABLE PPO INS COMPANY]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar standard_charge|[payer_USABLE PPO INS COMPANY]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage standard_charge|[payer_USABLE PPO INS COMPANY]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm estimated_amount|[payer_USABLE PPO INS COMPANY]|[plan_ MGD MEDICARE PHYS] standard_charge|[payer_USABLE PPO INS COMPANY]|[plan_ MGD MEDICARE PHYS] |methodology additional_payer_notes |[payer_USABLE PPO INS COMPANY]|[Plan_ MGD MEDICARE PHYS] "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ HMO/PPO]|negotiated_dollar" "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ HMO/PPO] |negotiated_percentage" "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ HMO/PPO] |negotiated_algorithm" "estimated_amount|[payer_VANTAGE HEALTH PLAN]|[plan_ HMO/PPO] " "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ HMO/PPO] |methodology" "additional_payer_notes |[payer_VANTAGE HEALTH PLAN]|[Plan_ HMO/PPO]" "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_VANTAGE HEALTH PLAN]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_VANTAGE HEALTH PLAN]|[Plan_ MGD MEDICARE PHYS]" "standard_charge|[payer_WELLCARE OF TEXAS]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_WELLCARE OF TEXAS]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_WELLCARE OF TEXAS]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_WELLCARE OF TEXAS]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_WELLCARE OF TEXAS]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_WELLCARE OF TEXAS]|[Plan_ MGD MEDICARE PHYS]" "standard_charge|[payer_WELLMED]|[plan_ MGD MEDICARE PHYS]|negotiated_dollar" "standard_charge|[payer_WELLMED]|[plan_ MGD MEDICARE PHYS] |negotiated_percentage" "standard_charge|[payer_WELLMED]|[plan_ MGD MEDICARE PHYS] |negotiated_algorithm" "estimated_amount|[payer_WELLMED]|[plan_ MGD MEDICARE PHYS] " "standard_charge|[payer_WELLMED]|[plan_ MGD MEDICARE PHYS] |methodology" "additional_payer_notes |[payer_WELLMED]|[Plan_ MGD MEDICARE PHYS]" additional_generic_notes ROOM AND BOARD ADOLESCENT ACUTE 124 RC facility Inpatient 1860 600 448 1860 785 per diem 830 per diem 840 per diem 680 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD ADULT ACUTE 124 RC facility Inpatient 1860 600 448 1860 785 per diem 830 per diem 840 per diem 680 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD CHILD ACUTE 124 RC facility Inpatient 1860 600 448 1860 785 per diem 830 per diem 840 per diem 680 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD GERI ACUTE 124 RC facility Inpatient 1860 600 448 1860 785 per diem 830 per diem 840 per diem 680 per diem 800 per diem 524 per diem 448 per diem 783 per diem 798 per diem 924 per diem 783 per diem 783 per diem 783 per diem 800 per diem 700 per diem 800 per diem 796 per diem 783 per diem 600 per diem 1860 per diem 1082 per diem 1100 per diem 785 per diem 485 per diem 779 per diem 783 per diem 767 per diem 800 per diem 951 per diem 698 per diem 767 per diem 830 per diem 498 per diem 1210 per diem 485 per diem 597 per diem 465 per diem 783 per diem 524 per diem 623 per diem 623 per diem 623 per diem 796 per diem 623 per diem 485 per diem 524 per diem 575 per diem 524 per diem 524 per diem 753 per diem 790 per diem 790 per diem 758 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem 950 per diem ROOM AND BOARD ADULT DETOX 126 RC facility Inpatient 1860 600 485 1082 785 per diem 745 per diem 840 per diem 680 per diem 800 per diem 798 per diem 924 per diem 800 per diem 700 per diem 800 per diem 796 per diem 1082 per diem 785 per diem 485 per diem 767 per diem 800 per diem 951 per diem 767 per diem 745 per diem 1000 per diem 485 per diem 623 per diem 796 per diem 623 per diem 485 per diem 753 per diem 790 per diem 790 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem ROOM AND BOARD GERI DETOX 126 RC facility Inpatient 1860 600 485 1082 785 per diem 745 per diem 840 per diem 680 per diem 800 per diem 798 per diem 924 per diem 800 per diem 700 per diem 800 per diem 796 per diem 1082 per diem 785 per diem 485 per diem 767 per diem 800 per diem 951 per diem 767 per diem 745 per diem 1000 per diem 485 per diem 623 per diem 796 per diem 623 per diem 485 per diem 753 per diem 790 per diem 790 per diem 758 per diem 790 per diem 796 per diem 758 per diem 790 per diem 796 per diem ROOM AND BOARD RTU ADOLESCENT 129 RC facility Inpatient 1100 500 935 620 per diem 800 per diem 626 per diem 800 per diem 626 per diem 626 per diem 800 per diem 500 per diem 800 per diem 626 per diem 857 per diem 935 per diem 626 per diem 626 per diem 650 per diem 524 per diem 572 per diem 620 per diem 800 per diem 530 per diem 560 per diem 589 per diem 560 per diem 589 per diem ROOM AND BOARD RTU ADULT 129 RC facility Inpatient 1100 500 935 620 per diem 800 per diem 626 per diem 800 per diem 626 per diem 626 per diem 800 per diem 500 per diem 800 per diem 626 per diem 857 per diem 935 per diem 626 per diem 626 per diem 650 per diem 524 per diem 572 per diem 620 per diem 800 per diem 530 per diem 560 per diem 589 per diem 560 per diem 589 per diem ROOM AND BOARD RTU CHILD 129 RC facility Inpatient 1100 500 935 620 per diem 800 per diem 626 per diem 800 per diem 626 per diem 626 per diem 800 per diem 500 per diem 800 per diem 626 per diem 857 per diem 935 per diem 626 per diem 626 per diem 650 per diem 524 per diem 572 per diem 620 per diem 800 per diem 530 per diem 560 per diem 589 per diem 560 per diem 589 per diem INTENSIVE OUTPATIENT PROGRAM 905 RC facility Outpatient 480 200 126 260 180 per diem 126 per diem 162 per diem 162 per diem 156 per diem 206 per diem 162 per diem 150 per diem 162 per diem 157 per diem 206 per diem 150 per diem 175 per diem 212 per diem 195 per diem 135 per diem 139 per diem 244 per diem 206 per diem 200 per diem 135 per diem 206 per diem 180 per diem 220 per diem 143 per diem 132 per diem 132 per diem 139 per diem 132 per diem 139 per diem 157 per diem 260 per diem INDIVIDUAL THERAPY 915 RC facility Outpatient 160 68 157 206 206 per diem 157 per diem 206 per diem 206 per diem 206 per diem 157 per diem PSYCH DIAG INTERVIEW FOR MED 90792 CPT facility both 132 74 213 135 fee schedule 132 fee schedule 187 fee schedule 187 fee schedule 195 fee schedule 132 fee schedule 194 fee schedule 135 fee schedule 132 fee schedule 132 fee schedule 132 fee schedule 194 fee schedule 195 fee schedule 180 fee schedule 132 fee schedule 139 fee schedule 132 fee schedule 132 fee schedule 132 fee schedule 74 fee schedule 132 fee schedule 132 fee schedule 213 fee schedule 145 fee schedule 132 fee schedule 132 fee schedule 135 fee schedule 160 fee schedule 213 fee schedule 213 fee schedule 213 fee schedule 139 fee schedule 132 fee schedule 132 fee schedule 132 fee schedule 132 fee schedule INITIAL HOSPITAL/PHP LOW 99221 CPT facility both 185 63 128 108 fee schedule 92 fee schedule 96 fee schedule 96 fee schedule 118 fee schedule 92 fee schedule 118 fee schedule 108 fee schedule 92 fee schedule 92 fee schedule 92 fee schedule 118 fee schedule 118 fee schedule 128 fee schedule 92 fee schedule 63 fee schedule 92 fee schedule 92 fee schedule 92 fee schedule 74 fee schedule 92 fee schedule 92 fee schedule 91 fee schedule 97 fee schedule 92 fee schedule 92 fee schedule 108 fee schedule 88 fee schedule 91 fee schedule 91 fee schedule 91 fee schedule 63 fee schedule 92 fee schedule 92 fee schedule 92 fee schedule 92 fee schedule INITIAL HOSPITAL/PHP MODERAT 99222 CPT facility both 284 81 176 147 fee schedule 125 fee schedule 139 fee schedule 139 fee schedule 159 fee schedule 125 fee schedule 159 fee schedule 147 fee schedule 125 fee schedule 125 fee schedule 125 fee schedule 176 fee schedule 159 fee schedule 159 fee schedule 125 fee schedule 114 fee schedule 125 fee schedule 125 fee schedule 125 fee schedule 81 fee schedule 125 fee schedule 125 fee schedule 131 fee schedule 131 fee schedule 125 fee schedule 125 fee schedule 147 fee schedule 119 fee schedule 131 fee schedule 131 fee schedule 131 fee schedule 114 fee schedule 125 fee schedule 125 fee schedule 125 fee schedule 125 fee schedule INITIAL HOSPTIAL/PHP HIGH 99223 CPT facility both 60 175 276 217 fee schedule 184 fee schedule 213 fee schedule 213 fee schedule 235 fee schedule 184 fee schedule 235 fee schedule 217 fee schedule 184 fee schedule 184 fee schedule 184 fee schedule 235 fee schedule 235 fee schedule 261 fee schedule 184 fee schedule 195 fee schedule 184 fee schedule 184 fee schedule 184 fee schedule 276 fee schedule 184 fee schedule 184 fee schedule 202 fee schedule 195 fee schedule 184 fee schedule 184 fee schedule 217 fee schedule 175 fee schedule 202 fee schedule 202 fee schedule 202 fee schedule 195 fee schedule 184 fee schedule 184 fee schedule 184 fee schedule 184 fee schedule SUBSEQUENT HOSP/PHP LOW 99231 CPT facility both 94 28 50 42 fee schedule 36 fee schedule 49 fee schedule 49 fee schedule 45 fee schedule 36 fee schedule 45 fee schedule 42 fee schedule 36 fee schedule 36 fee schedule 36 fee schedule 45 fee schedule 45 fee schedule 50 fee schedule 36 fee schedule 43 fee schedule 36 fee schedule 36 fee schedule 36 fee schedule 28 fee schedule 36 fee schedule 36 fee schedule 43 fee schedule 38 fee schedule 36 fee schedule 36 fee schedule 42 fee schedule 34 fee schedule 43 fee schedule 43 fee schedule 43 fee schedule 43 fee schedule 36 fee schedule 36 fee schedule 36 fee schedule 36 fee schedule SUBSEQUENT HOSP/PHP MODERATE 99232 CPT facility both 154 37 94 78 fee schedule 67 fee schedule 73 fee schedule 73 fee schedule 80 fee schedule 67 fee schedule 94 fee schedule 78 fee schedule 67 fee schedule 67 fee schedule 67 fee schedule 94 fee schedule 85 fee schedule 94 fee schedule 67 fee schedule 56 fee schedule 67 fee schedule 67 fee schedule 67 fee schedule 37 fee schedule 67 fee schedule 66 fee schedule 57 fee schedule 70 fee schedule 67 fee schedule 67 fee schedule 78 fee schedule 63 fee schedule 57 fee schedule 57 fee schedule 57 fee schedule 56 fee schedule 67 fee schedule 67 fee schedule 67 fee schedule 67 fee schedule SUBSEQUENT HOSP/PHP HIGH 99233 CPT facility both 94 81 122 112 fee schedule 95 fee schedule 116 fee schedule 116 fee schedule 122 fee schedule 95 fee schedule 122 fee schedule 112 fee schedule 95 fee schedule 95 fee schedule 95 fee schedule 122 fee schedule 122 fee schedule 122 fee schedule 95 fee schedule 108 fee schedule 95 fee schedule 95 fee schedule 95 fee schedule 81 fee schedule 95 fee schedule 95 fee schedule 109 fee schedule 100 fee schedule 95 fee schedule 95 fee schedule 112 fee schedule 91 fee schedule 109 fee schedule 109 fee schedule 109 fee schedule 108 fee schedule 95 fee schedule 95 fee schedule 95 fee schedule 95 fee schedule DISCHARGE HOSP/PHP LOW 99238 CPT facility both 42 92 78 fee schedule 70 fee schedule 78 fee schedule 78 fee schedule 92 fee schedule 66 fee schedule 84 fee schedule 78 fee schedule 66 fee schedule 66 fee schedule 66 fee schedule 92 fee schedule 84 fee schedule 92 fee schedule 70 fee schedule 64 fee schedule 66 fee schedule 66 fee schedule 66 fee schedule 42 fee schedule 66 fee schedule 66 fee schedule 65 fee schedule 70 fee schedule 66 fee schedule 66 fee schedule 78 fee schedule 63 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule 64 fee schedule 66 fee schedule 70 fee schedule 66 fee schedule 70 fee schedule