hospital_name last_updated_on version hospital_location hospital_address license_number|LA "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." "Vermilion Hospital, LLC" 5/31/2024 2.0.0 "Lafayette, Louisiana" 2520 North University Avenue license_ 2203783724 | LA TRUE description code|1 code|1|type setting drug_unit_of_measurement drug_type_of_measurement standard_charge | gross standard_charge|discounted_cash modifiers 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|MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH|MNGD MEDICAID]|negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH|MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH|MNGD MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH|MNGD MEDICAID]|methodology additional_payer_notes |[payer_AETNA BETTER HEALTH|MNGD MEDICAID] standard_charge|[payer_AETNA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] standard_charge|[payer_AETNA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_AETNA MEDICARE ADVANTAGE]|[plan_MNGD MEDICARE] standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_AITHER HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_AITHER HEALTH]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_AITHER HEALTH]|[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_ALLIED TRADES]|[plan_ Commercial ] |negotiated_dollar standard_charge|[payer_ALLIED TRADES]|[plan_ Commercial ]|negotiated_percentage standard_charge|[payer_ALLIED TRADES]|[plan_ Commercial ] |negotiated_algorithm estimated_amount|[payer_ALLIED TRADES]|[plan_ Commercial ] standard_charge|[payer_ALLIED TRADES]|[plan_ Commercial ]|methodology additional_payer_notes |[payer_ALLIED TRADES]|[plan_ Commercial ] standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MNGD MEDICAID]|negotiated_percentage standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_AMERIHEALTH CARITAS]|[plan_MNGD MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MNGD MEDICAID]|methodology additional_payer_notes |[payer_AMERIHEALTH CARITAS]|[plan_MNGD MEDICAID] standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_ANTHEM MAINE HEALTH-MEDIC]|[plan_MNGD MEDICARE] standard_charge|[payer_ANTHEM MAINE HEALTH-MEDIC]|[plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_ANTHEM MAINE HEALTH-MEDIC]|[plan_MNGD MEDICARE] standard_charge|[payer_APS HEALTHCARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_APS HEALTHCARE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_APS HEALTHCARE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_APS HEALTHCARE]|[plan_HMO/PPO]|[plan_HMO/PPO] standard_charge|[payer_APS HEALTHCARE]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_APS HEALTHCARE]|[plan_HMO/PPO] standard_charge|[payer_BCBS ADVANTAGE MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS ADVANTAGE MEDICARE]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_BCBS ADVANTAGE MEDICARE]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_BCBS ADVANTAGE MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_BCBS ADVANTAGE MEDICARE]|[plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_BCBS ADVANTAGE MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_BCBS FEDERA0]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS FEDERA0]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS FEDERA0]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS FEDERA0]|[plan_BLUE CROSS] standard_charge|[payer_BCBS FEDERA0]|[plan_BLUE CROSS]|methodology additional_payer_notes |[payer_BCBS FEDERA0]|[plan_BLUE CROSS] standard_charge|[payer_BCBS LOUISIANA]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS LOUISIANA]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS LOUISIANA]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS LOUISIANA]|[plan_BLUE CROSS] standard_charge|[payer_BCBS LOUISIANA]|[plan_BLUE CROSS]|methodology additional_payer_notes |[payer_BCBS LOUISIANA]|[plan_BLUE CROSS] standard_charge|[payer_BEACON HEALTH STRATEGIES]|]plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_BEACON HEALTH STRATEGIES]|]plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_BEACON HEALTH STRATEGIES]|]plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_BEACON HEALTH STRATEGIES]|]plan_MNGD MEDICARE] standard_charge|[payer_BEACON HEALTH STRATEGIES]|]plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_BEACON HEALTH STRATEGIES]|]plan_MNGD MEDICARE] standard_charge|[payer_CARELON]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CARELON]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_CARELON]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CARELON]|[plan_HMO/PPO] standard_charge|[payer_CARELON]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_CARELON]|[plan_HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_COMMUNITY CARE OF OK]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_COMMUNITY CARE OF OK]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_COMMUNITY CARE OF OK]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_COMMUNITY CARE OF OK]|[plan_HMO/PPO] standard_charge|[payer_COMMUNITY CARE OF OK]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_COMMUNITY CARE OF OK]|[plan_HMO/PPO] standard_charge|[payer_COUSHATTA HEALTH DEPT]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_COUSHATTA HEALTH DEPT]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_COUSHATTA HEALTH DEPT]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_COUSHATTA HEALTH DEPT]|[plan_COMMERCIAL] standard_charge|[payer_COUSHATTA HEALTH DEPT]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_COUSHATTA HEALTH DEPT]|[plan_COMMERCIAL] standard_charge|[payer_DCFS]|[plans_MEDICAID]|negotiated_dollar standard_charge|[payer_DCFS]|[plans_MEDICAID]|negotiated_percentage standard_charge|[payer_DCFS]|[plans_MEDICAID]|negotiated_algorithm estimated_amount|[payer_DCFS]|[plans_MEDICAID] standard_charge|[payer_DCFS]|[plans_MEDICAID]|methodology additional_payer_notes |[payer_DCFS]|[plans_MEDICAID] standard_charge|[payer_ENTRUST CLAIMS TEAM]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ENTRUST CLAIMS TEAM]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_ENTRUST CLAIMS TEAM]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_ENTRUST CLAIMS TEAM]|[plan_COMMERCIAL] standard_charge|[payer_ENTRUST CLAIMS TEAM]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_ENTRUST CLAIMS TEAM]|[plan_COMMERCIAL] 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_GILSBAR-CIGNA]|[plan_HMO/PPO] |negotiated_dollar standard_charge|[payer_GILSBAR-CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GILSBAR-CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GILSBAR-CIGNA]|[plan_HMO/PPO] standard_charge|[payer_GILSBAR-CIGNA]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_GILSBAR-CIGNA]|[plan_HMO/PPO] standard_charge|[payer_GULF SOUTH RISK SERV]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GULF SOUTH RISK SERV]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_GULF SOUTH RISK SERV]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_GULF SOUTH RISK SERV]|[plan_COMMERCIAL] standard_charge|[payer_GULF SOUTH RISK SERV]|[plan_COMMERCIAL]| methodology additional_payer_notes |[payer_GULF SOUTH RISK SERV]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH BLUE]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_HEALTH BLUE]|[plan_ MEDICAID]|negotiated_percentage standard_charge|[payer_HEALTH BLUE]|[plan_ MEDICAID]|negotiated_algorithm estimated_amount|[payer_HEALTH BLUE]|[plan_ MEDICAID]|[plan_HMO/PPO] standard_charge|[payer_HEALTH BLUE]|[plan_ MEDICAID]|methodology additional_payer_notes |[payer_HEALTH BLUE]|[plan_ MEDICAID] standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_HUMANA GOLD MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_HUMANA GOLD MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_HUMANA MEDICAID]|[plan_MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_HUMANA MEDICAID]|[plan_MNGD MEDICAID]|negotiated_percentage standard_charge|[payer_HUMANA MEDICAID]|[plan_MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_HUMANA MEDICAID]|[plan_MNGD MEDICAID] standard_charge|[payer_HUMANA MEDICAID]|[plan_MNGD MEDICAID]|methodology additional_payer_notes |[payer_HUMANA MEDICAID]|[plan_MNGD MEDICAID] standard_charge|[payer_IBH-CIGNA/ADOLESCENT]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_IBH-CIGNA/ADOLESCENT]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_IBH-CIGNA/ADOLESCENT]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_IBH-CIGNA/ADOLESCENT]|[plan_HMO/PPO] standard_charge|[payer_IBH-CIGNA/ADOLESCENT]|[plan_HMO/PPO]| methodology additional_payer_notes |[payer_IBH-CIGNA/ADOLESCENT]|[plan_HMO/PPO] standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_INTERFACE EAP]|[plan_HMO/PPO] standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_INTERFACE EAP]|[plan_HMO/PPO] standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MNGD MEDICAID]|negotiated_percentage standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MNGD MEDICAID] standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MNGD MEDICAID]|methodology additional_payer_notes |[payer_LA HEALTHCARE CONNECTIONS]|[plan_MNGD MEDICAID] standard_charge|[payer_LINECO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_LINECO]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_LINECO]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_LINECO]|[plan_HMO/PPO] standard_charge|[payer_LINECO]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_LINECO]|[plan_HMO/PPO] standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_LUCENT HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_MEDICAID MAGELLAN CSOC]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_MEDICAID MAGELLAN CSOC]|[plan_MEDICAID]|negotiated_percentage standard_charge|[payer_MEDICAID MAGELLAN CSOC]|[plan_MEDICAID]|negotiated_algorithm estimated_amount|[payer_MEDICAID MAGELLAN CSOC]|[plan_MEDICAID] standard_charge|[payer_MEDICAID MAGELLAN CSOC]|[plan_MEDICAID]| methodology additional_payer_notes |[payer_MEDICAID MAGELLAN CSOC]|[plan_MEDICAID] standard_charge|[payer_MEDICAID PENDING]|[plan_Medicaid]|negotiated_dollar standard_charge|[payer_MEDICAID PENDING]|[plan_Medicaid]|negotiated_percentage standard_charge|[payer_MEDICAID PENDING]|[plan_Medicaid]|negotiated_algorithm estimated_amount|[payerMEDICAID PENDING]|[plan_Medicaid] standard_charge|[payer_MEDICAID PENDING]|[plan_Medicaid]|methodology additional_payer_notes |[payer_MEDICAID PENDING]|[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_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_MGMT HEALTH NET]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MGMT HEALTH NET]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_MGMT HEALTH NET]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_MGMT HEALTH NET]|[plan_COMMERCIAL] standard_charge|[payer_MGMT HEALTH NET]|[plan_COMMERCIAL]| methodology additional_payer_notes |[payer_MGMT HEALTH NET]|[plan_COMMERCIAL] standard_charge|[payer_MHNET PPO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MHNET PPO]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MHNET PPO]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MHNET PPO]|[plan_HMO/PPO] standard_charge|[payer_MHNET PPO]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MHNET PPO]|[plan_HMO/PPO] standard_charge|[payer_MISC]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_MISC]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_MISC]|[plan_COMMERCIAL] standard_charge|[payer_MISC]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_MISC]|[plan_COMMERCIAL] standard_charge|[payer_MOLINA HEALTHCARE OHIO]|[plan_Medicaid]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OHIO]|[plan_Medicaid]|negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OHIO]|[plan_Medicaid]|negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OHIO]|[plan_Medicaid] standard_charge|[payer_MOLINA HEALTHCARE OHIO]|[plan_Medicaid]|methodology additional_payer_notes |[payer_MOLINA HEALTHCARE OHIO]|[plan_Medicaid] standard_charge|[payer_OFFICE OF JUVENILE JUSTIC]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_OFFICE OF JUVENILE JUSTIC]|[plan_MEDICAID]|negotiated_percentage standard_charge|[payer_OFFICE OF JUVENILE JUSTIC]|[plan_MEDICAID]|negotiated_algorithm estimated_amount|[payer_OFFICE OF JUVENILE JUSTIC]|[plan_MEDICAID] standard_charge|[payer_OFFICE OF JUVENILE JUSTIC]|[plan_MEDICAID]|methodology additional_payer_notes |[payer_OFFICE OF JUVENILE JUSTIC]|[plan_MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MNGD MEDICAID]|negotiated_percentage standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MNGD MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MNGD MEDICAID]|methodology additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MNGD MEDICAID] standard_charge|[payer_OPTUM MEDICARE HMO]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM MEDICARE HMO]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_OPTUM MEDICARE HMO]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_OPTUM MEDICARE HMO]|[plan_MNGD MEDICARE] standard_charge|[payer_OPTUM MEDICARE HMO]|[plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_OPTUM MEDICARE HMO]|[plan_MNGD MEDICARE] standard_charge|[payer_OPTUM VACCN]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_OPTUM VACCN]|[plan_VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_OPTUM VACCN]|[plan_VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_OPTUM VACCN]|[plan_VETERANS ADMIN] standard_charge|[payer_OPTUM VACCN]|[plan_VETERANS ADMIN]|methodology additional_payer_notes |[payer_OPTUM VACCN]|[plan_VETERANS ADMIN] standard_charge|[payer_PEOPLES HEALTH-MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_PEOPLES HEALTH-MEDICARE]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_PEOPLES HEALTH-MEDICARE]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_PEOPLES HEALTH-MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_PEOPLES HEALTH-MEDICARE]|[plan_MNGD MEDICARE]|methodology additional_payer_notes |[payer_PEOPLES HEALTH-MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_PHCS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_PHCS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_PHCS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_PHCS]|[plan_HMO/PPO] standard_charge|[payer_PHCS]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_PHCS]|[plan_HMO/PPO] standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] standard_charge|[payer_SEMPER FI]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_SEMPER FI]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_SEMPER FI]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_SEMPER FI]|[plan_COMMERCIAL] standard_charge|[payer_SEMPER FI]|[plan_COMMERCIAL]| methodology additional_payer_notes |[payer_SEMPER FI]|[plan_COMMERCIAL] standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_MNGD MEDICAID]|negotiated_percentage standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_SUPERIOR HEALTHPLAN]|[plan_MNGD MEDICAID] standard_charge|[payer_SUPERIOR HEALTHPLAN]|[plan_MNGD MEDICAID]| methodology additional_payer_notes |[payer_SUPERIOR HEALTHPLAN]|[plan_MNGD MEDICAID] 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_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 SOUTH]|[plan_Tricare]|negotiated_dollar standard_charge|[payer_TRICARE SOUTH]|[plan_Tricare]|negotiated_percentage standard_charge|[payer_TRICARE SOUTH]|[plan_Tricare]|negotiated_algorithm estimated_amount|[payer_TRICARE SOUTH]|[plan_Tricare] standard_charge|[payer_TRICARE SOUTH]|[plan_Tricare]| methodology additional_payer_notes |[payer_TRICARE SOUTH]|[plan_Tricare] standard_charge|[payer_TRICARE WEST]|[plan_Tricare]|negotiated_dollar standard_charge|[payer_TRICARE WEST]|[plan_Tricare]|negotiated_percentage standard_charge|[payer_TRICARE WEST]|[plan_Tricare]|negotiated_algorithm estimated_amount|[payer_TRICARE WEST]|[plan_Tricare] standard_charge|[payer_TRICARE WEST]|[plan_Tricare]|methodology additional_payer_notes |[payer_TRICARE WEST]|[plan_Tricare] standard_charge|[payer_TRIWEST WPS ]|[plan_VA]|negotiated_dollar standard_charge|[payer_TRIWEST WPS ]|[plan_VA] |negotiated_percentage standard_charge|[payer_TRIWEST WPS ]|[plan_VA]|negotiated_algorithm estimated_amount|[payer_TRIWEST WPS ]|[plan_VA] standard_charge|[payer_TRIWEST WPS ]|[plan_VA]| methodology additional_payer_notes |[payer_TRIWEST WPS ]|[plan_VA] standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_TUNICA-BILOXI TRIBE OF LA]|[plan_HMO/PPO] standard_charge|[payer_TUNICA-BILOXI TRIBE OF LA]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_TUNICA-BILOXI TRIBE OF LA]|[plan_HMO/PPO] standard_charge|[payer_UHC GEHA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC GEHA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UHC GEHA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UHC GEHA]|[plan_HMO/PPO] standard_charge|[payer_UHC GEHA]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UHC GEHA]|[plan_HMO/PPO] standard_charge|[payer_UHC MEDICARE SOLUTIONS]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_UHC MEDICARE SOLUTIONS]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_UHC MEDICARE SOLUTIONS]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_UHC MEDICARE SOLUTIONS]|[plan_MNGD MEDICARE] standard_charge|[payer_UHC MEDICARE SOLUTIONS]|[plan_MNGD MEDICARE]| methodology additional_payer_notes |[payer_UHC MEDICARE SOLUTIONS]|[plan_MNGD MEDICARE] standard_charge|[payer_UHC STUDENT]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC STUDENT]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UHC STUDENT]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UHC STUDENT]|[plan_HMO/PPO] standard_charge|[payer_UHC STUDENT]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UHC STUDENT]|[plan_HMO/PPO] standard_charge|[payer_UHC/UBH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC/UBH]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UHC/UBH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UHC/UBH]|[plan_HMO/PPO] standard_charge|[payer_UHC/UBH]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UHC/UBH]|[plan_HMO/PPO] 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_VALUE OPTIONS]|]plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_VALUE OPTIONS]|]plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_VALUE OPTIONS]|]plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_VALUE OPTIONS]|]plan_HMO/PPO] standard_charge|[payer_VALUE OPTIONS]|]plan_HMO/PPO]|methodology additional_payer_notes |[payer_VALUE OPTIONS]|]plan_HMO/PPO] standard_charge|[payer_VANTAGE HEALTH COMMERCIAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH COMMERCIAL]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_VANTAGE HEALTH COMMERCIAL]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_VANTAGE HEALTH COMMERCIAL]|[plan_HMO/PPO]| methodology additional_payer_notes |[payer_VANTAGE HEALTH COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_VANTAGE HEALTH MCARE HMO]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH MCARE HMO]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_VANTAGE HEALTH MCARE HMO]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH MCARE HMO]|[plan_MNGD MEDICARE] standard_charge|[payer_VANTAGE HEALTH MCARE HMO]|[plan_MNGD MEDICARE]| methodology additional_payer_notes |[payer_VANTAGE HEALTH MCARE HMO]|[plan_MNGD MEDICARE] standard_charge|[payer_VERITY]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_VERITY]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_VERITY]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_VERITY]|[plan_HMO/PPO] standard_charge|[payer_VERITY]|[plan_HMO/PPO]| methodology additional_payer_notes |[payer_VERITY]|[plan_HMO/PPO] standard_charge|[payer_VERITY-PGRMA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_VERITY-PGRMA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_VERITY-PGRMA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_VERITY-PGRMA]|[plan_HMO/PPO] standard_charge|[payer_VERITY-PGRMA]|[plan_HMO/PPO]| methodology additional_payer_notes |[payer_VERITY-PGRMA]|[plan_HMO/PPO] 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_VETERANS CHOICE VACAA]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VETERANS CHOICE VACAA]|[plan_VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_VETERANS CHOICE VACAA]|[plan_VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_VETERANS CHOICE VACAA]|[plan_VETERANS ADMIN] standard_charge|[payer_VETERANS CHOICE VACAA]|[plan_VETERANS ADMIN]| methodology additional_payer_notes |[payer_VETERANS CHOICE VACAA]|[plan_VETERANS ADMIN] standard_charge|[payer_WEBTPA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_WEBTPA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_WEBTPA]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_WEBTPA]|[plan_COMMERCIAL] standard_charge|[payer_WEBTPA]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_WEBTPA]|[plan_COMMERCIAL] standard_charge|[payer_WELL MED MEDICARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_WELL MED MEDICARE]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_WELL MED MEDICARE]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_WELL MED MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_WELL MED MEDICARE]|[plan_MNGD MEDICARE]| methodology additional_payer_notes |[payer_WELL MED MEDICARE]|[plan_MNGD MEDICARE] standard_charge|[payer_WELLCARE]|[plan_MNGD MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE]|[plan_MNGD MEDICARE]|negotiated_percentage standard_charge|[payer_WELLCARE]|[plan_MNGD MEDICARE]|negotiated_algorithm estimated_amount|[payer_WELLCARE]|[plan_MNGD MEDICARE] standard_charge|[payer_WELLCARE]|[plan_MNGD MEDICARE]| methodology additional_payer_notes |[payer_WELLCARE]|[plan_MNGD MEDICARE] standard_charge|[payer_WELLCARE KY MEDICAID]|[plan_MNGD MEDICAID]|negotiated_dollar standard_charge|[payer_WELLCARE KY MEDICAID]|[plan_MNGD MEDICAID] |negotiated_percentage standard_charge|[payer_WELLCARE KY MEDICAID]|[plan_MNGD MEDICAID]|negotiated_algorithm estimated_amount|[payer_WELLCARE KY MEDICAID]|[plan_MNGD MEDICAID] standard_charge|[payer_WELLCARE KY MEDICAID]|[plan_MNGD MEDICAID]|methodology additional_payer_notes |[payer_WELLCARE KY MEDICAID]|[plan_MNGD MEDICAID] standard_charge|[payer_ZELIS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ZELIS]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_ZELIS]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_ZELIS]|[plan_COMMERCIAL] standard_charge|[payer_ZELIS]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_ZELIS]|[plan_COMMERCIAL] standard_charge|min standard_charge | max additional_generic_notes EAST-ROOM&BOARD PSYCH ADOLESCENT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 EAST-ROOM&BOARD PSYCH ADULT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 NORTH-ROOM&BOARD PSYCH ADOLESCENT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 NORTH-ROOM&BOARD PSYCH ADULT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 SOUTH-ROOM&BOARD PSYCH ADOLESCENT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 SOUTH-ROOM&BOARD PSYCH ADULT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 WEST-ROOM&BOARD PSYCH ADOLESCENT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 882 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 WEST-ROOM&BOARD PSYCH ADULT 124 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 825 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 869 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 EAST-ROOM&BOARD DETOX ADOLESCENT 126 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 907 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 872 per diem 937.3 per diem 792.95 per diem 835 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 650 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 774 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 EAST-ROOM&BOARD DETOX ADULT 126 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 NORTH-ROOM&BOARD DETOX ADULT 126 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 SOUTH-ROOM&BOARD DETOX ADULT 126 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 WEST-ROOM&BOARD DETOX ADULT 126 RC inpatient 2400 800 900 per diem 774.51 per diem 1060.5 per diem 783 per diem 885.66 per diem 774.51 per diem 774.51 per diem 830 per diem case rate 885.66 per diem 885.66 per diem 840 per diem 885.66 per diem 848 per diem 714.13 per diem 715 per diem 737.63 per diem 919.1 per diem 750 per diem 815 per diem 937.3 per diem 792.95 per diem 775 per diem case rate 781.89 per diem 872 per diem 600 per diem 811.39 per diem 840 per diem 1040 per diem 737.63 per diem 800 per diem 900 per diem 843.41 per diem 625 per diem 737.63 per diem 737.63 per diem 737.63 per diem case rate case rate 900 per diem 600 per diem 737.63 per diem 1048.1 per diem 934.11 per diem 800 per diem 783 per diem case rate 715 per diem 783 per diem 783 per diem 746 per diem 900 per diem case rate 850 per diem 850 per diem 900 per diem case rate 700 per diem 737.63 per diem 775 per diem 600 1060.5 INTENSIVE OUTPATIENT PROGRAM PSYCH PROGRAM-ADOLESCENT 905 RC outpatient 660 200 240 per diem 175 per diem 175 per diem 175 per diem 434.46 per diem 434.46 per diem 201 per diem 375 per diem 193 per diem 175 per diem 210 per diem 170 per diem 170 per diem 269 per diem 321.51 per diem 198.02 per diem 600 per diem 175 per diem 170 per diem 200 per diem 170 per diem 170 per diem 269 per diem 270 per diem 225 per diem 453.49 per diem 170 600 INTENSIVE OUTPATIENT PROGRAM PSYCH PROGRAM 905 RC outpatient 660 200 240 per diem 175 per diem 175 per diem 175 per diem 434.46 per diem 434.46 per diem 201 per diem 375 per diem 193 per diem 175 per diem 210 per diem 170 per diem 170 per diem 269 per diem 321.51 per diem 198.02 per diem 600 per diem 175 per diem 170 per diem 200 per diem 170 per diem 170 per diem 269 per diem 270 per diem 225 per diem 453.49 per diem 170 600 INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY GROUP 1 MCD 906 RC outpatient 660 240 per diem 144 per diem 144 per diem 144 per diem 433.12 per diem 433.12 per diem 144 per diem 210 per diem 144 per diem 192 per diem 144 per diem 127 per diem 127 per diem 127 per diem 269 per diem 453.49 per diem 127 453.49 INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY GROUP-ADOLESCENT 906 RC outpatient 660 240 per diem 144 per diem 144 per diem 144 per diem 144 per diem 210 per diem 144 per diem 192 per diem 144 per diem 127 per diem 127 per diem 127 per diem 269 per diem 453.49 per diem 127 453.49 PARTIAL HOSPITAL PROGRAM PSYCH PROGRAM 912 RC outpatient 860 300 460 per diem 229.65 per diem 534.72 per diem 534.72 per diem 410 per diem 400 per diem 394 per diem 300 per diem 534.72 per diem 229.65 per diem 800 per diem 144 per diem 285 per diem 211.67 per diem 229.65 per diem 300 per diem 285 per diem 285 per diem 370 per diem 375 per diem 436 per diem 144 800 GROUP PSYCHO THERAPY 915 RC outpatient 250 198.02 per diem 198.02 per diem 210 per diem 198.02 per diem 321.51 per diem 229.65 per diem 144 per diem 211.67 per diem 198.02 per diem 222.73 per diem 179.42 per diem 179.42 per diem 179.42 per diem 179.42 per diem 198.02 per diem 179.42 per diem 179.42 per diem 300 per diem 144 321.51 PROCESS GROUP/DAY INTENSICE OUTPATIENT PROGRAM 915 RC outpatient 220 198.02 per diem 198.02 per diem 198.02 per diem 321.51 per diem 229.65 per diem 144 per diem 211.67 per diem 198.02 per diem 222.73 per diem 179.42 per diem 179.42 per diem 179.42 per diem 179.42 per diem 198.02 per diem 179.42 per diem 179.42 per diem 300 per diem 144 321.51 PROCESS GROUP1/DAY INTENSICE OUTPATIENT PROGRAM 915 RC outpatient 150 198.02 per diem 198.02 per diem 198.02 per diem 321.51 per diem 229.65 per diem 144 per diem 211.67 per diem 198.02 per diem 222.73 per diem 179.42 per diem 179.42 per diem 179.42 per diem 179.42 per diem 198.02 per diem 179.42 per diem 179.42 per diem 300 per diem 144 321.51 Psych Eval - With Medical 90792 RC outpatient 250 157.16 fee schedule 115.62 fee schedule 115.62 fee schedule 115.62 fee schedule 75 fee schedule 134.38 fee schedule 129.91 fee schedule 171.02 fee schedule 134.38 fee schedule 134.38 fee schedule 62.5 fee schedule 62.5 171.02 Initial Hospital Care (50 Min) 99222 RC outpatient 210 87.95 fee schedule 102.41 fee schedule 102.41 fee schedule 140.83 fee schedule 77 fee schedule 122.05 fee schedule 107.59 fee schedule 122.05 fee schedule 122.05 fee schedule 77 140.83 Initial Hospital Care (70 Min) 99223 RC outpatient 500 134.38 fee schedule 134.38 134.38 Subseq Care (15 Min) 99231 RC outpatient 120 26.6 fee schedule 93.4 fee schedule 93.4 fee schedule 93.4 fee schedule 26.6 93.4 Subseq Care (25 Min) 99232 RC outpatient 140 82.4 fee schedule 47.34 fee schedule 93.58 fee schedule 93.58 fee schedule 131.96 fee schedule 70 fee schedule 67.6 fee schedule 92.16 fee schedule 88.89 fee schedule 84.29 fee schedule 92.16 fee schedule 92.16 fee schedule 92.16 fee schedule 47.34 131.96 Subseq Care (35 Min) 99233 RC outpatient 200 68.56 fee schedule 93.64 fee schedule 131.44 fee schedule 131.44 fee schedule 68.56 131.44 Discharge Day Mgmt <30 Min 99238 RC outpatient 160 82.4 fee schedule 47.25 fee schedule 114.65 fee schedule 114.65 fee schedule 86.02 fee schedule 80 fee schedule 48 fee schedule 112.75 fee schedule 114.15 fee schedule 112.75 fee schedule 112.75 fee schedule 112.75 fee schedule 47.25 114.65