hospital_name last_updated_on version hospital_location hospital_address license_number|MI "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded in this machine-readable file is true, accurate, and complete as of the date indicated in this file" "Austin Behavioral Hospital, LLC" 5/31/2024 2.0.0 "Austin, Texas" 8402 Cross Park Drive license_ 100290| TX 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_AARP MEDICARE COMPLETE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AARP MEDICARE COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AARP MEDICARE COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AARP MEDICARE COMPLETE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AARP MEDICARE COMPLETE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AARP MEDICARE COMPLETE]|[Plan_MANAGED MEDICARE] 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 OF TX]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH OF TX]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH OF TX]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH OF TX]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH OF TX]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AETNA BETTER HEALTH OF TX]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE]|[Plan_MANAGED MEDICARE] 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_AMBETTER INSURANCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER INSURANCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AMBETTER INSURANCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMBETTER INSURANCE]|[plan_HMO/PPO] standard_charge|[payer_AMBETTER INSURANCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AMBETTER INSURANCE]|[Plan_HMO/PPO] standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ANDREWS CENTER]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ANDREWS CENTER]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ANDREWS CENTER]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ANDREWS CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_ANDREWS CENTER]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ANDREWS CENTER]|[Plan_LOCAL GOVT] standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_ANTHEM BCBS]|[Plan_BLUE CROSS] standard_charge|[payer_APWU HEALTH PLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_APWU HEALTH PLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_APWU HEALTH PLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_APWU HEALTH PLAN]|[plan_HMO/PPO] standard_charge|[payer_APWU HEALTH PLAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_APWU HEALTH PLAN]|[Plan_HMO/PPO] standard_charge|[payer_ASCENSION COMPLETE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ASCENSION COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ASCENSION COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ASCENSION COMPLETE]|[plan_MANAGED MEDICARE] standard_charge|[payer_ASCENSION COMPLETE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ASCENSION COMPLETE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ATCIC PSYCH]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ATCIC PSYCH]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ATCIC PSYCH]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ATCIC PSYCH]|[plan_LOCAL GOVT] standard_charge|[payer_ATCIC PSYCH]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ATCIC PSYCH]|[Plan_LOCAL GOVT] standard_charge|[payer_BAS HEALTHCOMP]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BAS HEALTHCOMP]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BAS HEALTHCOMP]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BAS HEALTHCOMP]|[plan_HMO/PPO] standard_charge|[payer_BAS HEALTHCOMP]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BAS HEALTHCOMP]|[Plan_HMO/PPO] 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 MCAID MAGELLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BCBS MCAID MAGELLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BCBS MCAID MAGELLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BCBS MCAID MAGELLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_BCBS MCAID MAGELLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BCBS MCAID MAGELLAN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BCBS MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BCBS MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BCBS MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BCBS MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BCBS OOS ADVANTAGE HMO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OOS ADVANTAGE HMO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OOS ADVANTAGE HMO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OOS ADVANTAGE HMO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OOS ADVANTAGE HMO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OOS ADVANTAGE HMO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OOS HMO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OOS HMO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OOS HMO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OOS HMO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OOS HMO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OOS HMO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OOS PPO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OOS PPO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OOS PPO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OOS PPO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OOS PPO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OOS PPO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS ADVANTAGE HMO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS ADVANTAGE HMO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS TEXAS ADVANTAGE HMO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS TEXAS ADVANTAGE HMO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS ADVANTAGE HMO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS TEXAS ADVANTAGE HMO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS HMO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS HMO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS TEXAS HMO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS TEXAS HMO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS HMO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS TEXAS HMO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS PPO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS PPO]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS TEXAS PPO]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS TEXAS PPO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS PPO]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS TEXAS PPO]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS VA MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BCBS VA MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BCBS VA MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BCBS VA MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_BCBS VA MEDICAID]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BCBS VA MEDICAID]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS]|[Plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BEACON HEALTH STRATEGIES]|[Plan_HMO/PPO] standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH STRATEGIES]|[plan_MANAGED MEDICAID] standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BEACON HEALTH STRATEGIES]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BIND BENEFITS INC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BIND BENEFITS INC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BIND BENEFITS INC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BIND BENEFITS INC]|[plan_HMO/PPO] standard_charge|[payer_BIND BENEFITS INC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BIND BENEFITS INC]|[Plan_HMO/PPO] standard_charge|[payer_BLUEBONNET TRAILS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BLUEBONNET TRAILS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_BLUEBONNET TRAILS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_BLUEBONNET TRAILS]|[plan_LOCAL GOVT] standard_charge|[payer_BLUEBONNET TRAILS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_BLUEBONNET TRAILS]|[Plan_LOCAL GOVT] standard_charge|[payer_BOON CHAPMAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BOON CHAPMAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BOON CHAPMAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BOON CHAPMAN]|[plan_HMO/PPO] standard_charge|[payer_BOON CHAPMAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BOON CHAPMAN]|[Plan_HMO/PPO] standard_charge|[payer_BRAZOS VALLEY MHMR]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BRAZOS VALLEY MHMR]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_BRAZOS VALLEY MHMR]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_BRAZOS VALLEY MHMR]|[plan_LOCAL GOVT] standard_charge|[payer_BRAZOS VALLEY MHMR]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_BRAZOS VALLEY MHMR]|[Plan_LOCAL GOVT] standard_charge|[payer_BRIGHT HEALTHCARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BRIGHT HEALTHCARE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BRIGHT HEALTHCARE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BRIGHT HEALTHCARE]|[plan_HMO/PPO] standard_charge|[payer_BRIGHT HEALTHCARE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BRIGHT HEALTHCARE]|[Plan_HMO/PPO] standard_charge|[payer_CARE IMPROVEMENT]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARE IMPROVEMENT]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CARE IMPROVEMENT]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARE IMPROVEMENT]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CARE IMPROVEMENT]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CARELON BEHAVIORAL HE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARELON BEHAVIORAL HE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CARELON BEHAVIORAL HE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARELON BEHAVIORAL HE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARELON BEHAVIORAL HE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CARELON BEHAVIORAL HE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CENTER FOR LIFE RESOURCES]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CENTER FOR LIFE RESOURCES]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_CENTER FOR LIFE RESOURCES]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_CENTER FOR LIFE RESOURCES]|[plan_LOCAL GOVT] standard_charge|[payer_CENTER FOR LIFE RESOURCES]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_CENTER FOR LIFE RESOURCES]|[Plan_LOCAL GOVT] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMPVA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMPVA]|[Plan_VETERANS ADMIN] standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA BEHAVIORAL]|[Plan_HMO/PPO] standard_charge|[payer_CIGNA GREATWEST]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA GREATWEST]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA GREATWEST]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA GREATWEST]|[plan_HMO/PPO] standard_charge|[payer_CIGNA GREATWEST]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA GREATWEST]|[Plan_HMO/PPO] standard_charge|[payer_CIGNA HEALTHSPRINGS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHSPRINGS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHSPRINGS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHSPRINGS]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRINGS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTHSPRINGS]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CLOVER HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CLOVER HEALTH]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CLOVER HEALTH]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CLOVER HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_CLOVER HEALTH]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CLOVER HEALTH]|[Plan_MANAGED MEDICARE] standard_charge|[payer_COMMUNITY FIRST HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COMMUNITY FIRST HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_COMMUNITY FIRST HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_COMMUNITY FIRST HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_COMMUNITY FIRST HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_COMMUNITY FIRST HEALTH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_COMMUNITY FIRST HEALTH PL]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COMMUNITY FIRST HEALTH PL]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_COMMUNITY FIRST HEALTH PL]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_COMMUNITY FIRST HEALTH PL]|[plan_MANAGED MEDICAID] standard_charge|[payer_COMMUNITY FIRST HEALTH PL]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_COMMUNITY FIRST HEALTH PL]|[Plan_MANAGED MEDICAID] standard_charge|[payer_COMMUNITY HEALTH CHOICE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COMMUNITY HEALTH CHOICE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_COMMUNITY HEALTH CHOICE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_COMMUNITY HEALTH CHOICE]|[plan_MANAGED MEDICAID] standard_charge|[payer_COMMUNITY HEALTH CHOICE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_COMMUNITY HEALTH CHOICE]|[Plan_MANAGED MEDICAID] 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_CRIME VICTIMS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CRIME VICTIMS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_CRIME VICTIMS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_CRIME VICTIMS]|[plan_LOCAL GOVT] standard_charge|[payer_CRIME VICTIMS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_CRIME VICTIMS]|[Plan_LOCAL GOVT] standard_charge|[payer_DELL CHILDRENS MAGELLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_DELL CHILDRENS MAGELLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_DELL CHILDRENS MAGELLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_DELL CHILDRENS MAGELLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_DELL CHILDRENS MAGELLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_DELL CHILDRENS MAGELLAN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_DFPS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DFPS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DFPS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DFPS]|[plan_LOCAL GOVT] standard_charge|[payer_DFPS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DFPS]|[Plan_LOCAL GOVT] standard_charge|[payer_DRISCOLL HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_DRISCOLL HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_DRISCOLL HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_DRISCOLL HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_DRISCOLL HEALTH PLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_DRISCOLL HEALTH PLAN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_EMBLEM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_EMBLEM HEALTH]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_EMBLEM HEALTH]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_EMBLEM HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_EMBLEM HEALTH]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_EMBLEM HEALTH]|[Plan_MANAGED MEDICARE] standard_charge|[payer_FIRST CARE STAR]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_FIRST CARE STAR]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_FIRST CARE STAR]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_FIRST CARE STAR]|[plan_MANAGED MEDICAID] standard_charge|[payer_FIRST CARE STAR]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_FIRST CARE STAR]|[Plan_MANAGED MEDICAID] standard_charge|[payer_FOUNDATION COMMUNITIES]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_FOUNDATION COMMUNITIES]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_FOUNDATION COMMUNITIES]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_FOUNDATION COMMUNITIES]|[plan_LOCAL GOVT] standard_charge|[payer_FOUNDATION COMMUNITIES]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_FOUNDATION COMMUNITIES]|[Plan_LOCAL GOVT] standard_charge|[payer_FRIDAY HEALTH PLANS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_FRIDAY HEALTH PLANS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_FRIDAY HEALTH PLANS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FRIDAY HEALTH PLANS]|[plan_HMO/PPO] standard_charge|[payer_FRIDAY HEALTH PLANS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_FRIDAY HEALTH PLANS]|[Plan_HMO/PPO] standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FRINGE BENEFIT GROUP]|[plan_HMO/PPO] standard_charge|[payer_FRINGE BENEFIT GROUP]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_FRINGE BENEFIT GROUP]|[Plan_HMO/PPO] standard_charge|[payer_GULF BEND MHMR CENTER]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_GULF BEND MHMR CENTER]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_GULF BEND MHMR CENTER]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_GULF BEND MHMR CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_GULF BEND MHMR CENTER]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_GULF BEND MHMR CENTER]|[Plan_LOCAL GOVT] standard_charge|[payer_HALCYON]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HALCYON]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HALCYON]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HALCYON]|[plan_HMO/PPO] standard_charge|[payer_HALCYON]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HALCYON]|[Plan_HMO/PPO] standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTH PLAN OF NEVADA]|[plan_HMO/PPO] standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTH PLAN OF NEVADA]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHPARTNERS]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHSELECT OF TEXAS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_HEALTHSELECT OF TEXAS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_HEALTHSELECT OF TEXAS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_HEALTHSELECT OF TEXAS]|[plan_BLUE CROSS] standard_charge|[payer_HEALTHSELECT OF TEXAS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_HEALTHSELECT OF TEXAS]|[Plan_BLUE CROSS] standard_charge|[payer_HEALTHSMART PHYS & ANC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSMART PHYS & ANC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHSMART PHYS & ANC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHSMART PHYS & ANC]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSMART PHYS & ANC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHSMART PHYS & ANC]|[Plan_HMO/PPO] standard_charge|[payer_HILL COUNTRY MH]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_HILL COUNTRY MH]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_HILL COUNTRY MH]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_HILL COUNTRY MH]|[plan_LOCAL GOVT] standard_charge|[payer_HILL COUNTRY MH]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_HILL COUNTRY MH]|[Plan_LOCAL GOVT] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA GOLD CHOICE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ICE HEALTH SERVICES CORPS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ICE HEALTH SERVICES CORPS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ICE HEALTH SERVICES CORPS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ICE HEALTH SERVICES CORPS]|[plan_LOCAL GOVT] standard_charge|[payer_ICE HEALTH SERVICES CORPS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ICE HEALTH SERVICES CORPS]|[Plan_LOCAL GOVT] standard_charge|[payer_IMPERIAL INSURANCE CO]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_IMPERIAL INSURANCE CO]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_IMPERIAL INSURANCE CO]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_IMPERIAL INSURANCE CO]|[plan_MANAGED MEDICARE] standard_charge|[payer_IMPERIAL INSURANCE CO]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_IMPERIAL INSURANCE CO]|[Plan_MANAGED MEDICARE] standard_charge|[payer_INSURANCE BENEFIT ADMIN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_INSURANCE BENEFIT ADMIN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_INSURANCE BENEFIT ADMIN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_INSURANCE BENEFIT ADMIN]|[plan_HMO/PPO] standard_charge|[payer_INSURANCE BENEFIT ADMIN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_INSURANCE BENEFIT ADMIN]|[Plan_HMO/PPO] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN]|[Plan_HMO/PPO] standard_charge|[payer_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_MOLINA EXCHANGE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MOLINA EXCHANGE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MOLINA EXCHANGE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MOLINA EXCHANGE]|[plan_HMO/PPO] standard_charge|[payer_MOLINA EXCHANGE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MOLINA EXCHANGE]|[Plan_HMO/PPO] standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA HEALTHCARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_NINETY DEGREE BENEFITS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_NINETY DEGREE BENEFITS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_NINETY DEGREE BENEFITS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_NINETY DEGREE BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_NINETY DEGREE BENEFITS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_NINETY DEGREE BENEFITS]|[Plan_HMO/PPO] standard_charge|[payer_OPTUM]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM]|[plan_HMO/PPO] standard_charge|[payer_OPTUM]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM]|[Plan_HMO/PPO] standard_charge|[payer_OPTUM MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_OPTUM MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_OPTUM MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_OPTUM MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_OPTUM MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_PENDING MEDICAID]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_PENDING MEDICAID]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_PENDING MEDICAID]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_PENDING MEDICAID]|[plan_MEDICAID ] standard_charge|[payer_PENDING MEDICAID]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_PENDING MEDICAID]|[Plan_MEDICAID ] standard_charge|[payer_PHYSICIANS HEALTH CHOICE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_PHYSICIANS HEALTH CHOICE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_PHYSICIANS HEALTH CHOICE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_PHYSICIANS HEALTH CHOICE]|[plan_MANAGED MEDICARE] standard_charge|[payer_PHYSICIANS HEALTH CHOICE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_PHYSICIANS HEALTH CHOICE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_RIGHTCARE SCOTT AND WHITE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_RIGHTCARE SCOTT AND WHITE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_RIGHTCARE SCOTT AND WHITE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_RIGHTCARE SCOTT AND WHITE]|[plan_MANAGED MEDICAID] standard_charge|[payer_RIGHTCARE SCOTT AND WHITE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_RIGHTCARE SCOTT AND WHITE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SAMSO ATCIC]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_SAMSO ATCIC]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_SAMSO ATCIC]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_SAMSO ATCIC]|[plan_LOCAL GOVT] standard_charge|[payer_SAMSO ATCIC]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_SAMSO ATCIC]|[Plan_LOCAL GOVT] standard_charge|[payer_SANA BENEFITS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SANA BENEFITS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SANA BENEFITS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SANA BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_SANA BENEFITS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SANA BENEFITS]|[Plan_HMO/PPO] standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SCOTT AND WHITE HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_SCOTT AND WHITE HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SCOTT AND WHITE HEALTH]|[plan_HMO/PPO] standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SCOTT AND WHITE HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_SCOTT AND WHITE MKTPLACE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SCOTT AND WHITE MKTPLACE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SCOTT AND WHITE MKTPLACE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SCOTT AND WHITE MKTPLACE]|[plan_HMO/PPO] standard_charge|[payer_SCOTT AND WHITE MKTPLACE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SCOTT AND WHITE MKTPLACE]|[Plan_HMO/PPO] standard_charge|[payer_SCOTT AND WHITE PREFERRED]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SCOTT AND WHITE PREFERRED]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SCOTT AND WHITE PREFERRED]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SCOTT AND WHITE PREFERRED]|[plan_HMO/PPO] standard_charge|[payer_SCOTT AND WHITE PREFERRED]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SCOTT AND WHITE PREFERRED]|[Plan_HMO/PPO] standard_charge|[payer_SENDERO HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SENDERO HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SENDERO HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SENDERO HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_SENDERO HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SENDERO HEALTH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SENDERO IDEALCARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SENDERO IDEALCARE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SENDERO IDEALCARE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SENDERO IDEALCARE]|[plan_HMO/PPO] standard_charge|[payer_SENDERO IDEALCARE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SENDERO IDEALCARE]|[Plan_HMO/PPO] standard_charge|[payer_SENIOR CARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SENIOR CARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SENIOR CARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SENIOR CARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_SENIOR CARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SENIOR CARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_SIMS FOUNDATION]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SIMS FOUNDATION]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SIMS FOUNDATION]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SIMS FOUNDATION]|[plan_HMO/PPO] standard_charge|[payer_SIMS FOUNDATION]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SIMS FOUNDATION]|[Plan_HMO/PPO] standard_charge|[payer_STAR BCBS MCAID MAG UHRIP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_STAR BCBS MCAID MAG UHRIP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_STAR BCBS MCAID MAG UHRIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_STAR BCBS MCAID MAG UHRIP]|[plan_MANAGED MEDICAID] standard_charge|[payer_STAR BCBS MCAID MAG UHRIP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_STAR BCBS MCAID MAG UHRIP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_STAR DELL CHILDRENS UHRIP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_STAR DELL CHILDRENS UHRIP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_STAR DELL CHILDRENS UHRIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_STAR DELL CHILDRENS UHRIP]|[plan_MANAGED MEDICAID] standard_charge|[payer_STAR DELL CHILDRENS UHRIP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_STAR DELL CHILDRENS UHRIP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_STAR SUPERIOR UHRIP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_STAR SUPERIOR UHRIP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_STAR SUPERIOR UHRIP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_STAR SUPERIOR UHRIP]|[plan_MANAGED MEDICAID] standard_charge|[payer_STAR SUPERIOR UHRIP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_STAR SUPERIOR UHRIP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_STAR UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_STAR UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_STAR UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_STAR UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] standard_charge|[payer_STAR UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_STAR UHC COMM STAR PLUS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_STAR DRISCOLL]|[plan_CHIRP]|negotiated_dollar standard_charge|[payer_STAR DRISCOLL]|[plan_CHIRP]|negotiated_percentage standard_charge|[payer_STAR DRISCOLL]|[plan_CHIRP] |negotiated_algorithm estimated_amount|[payer_STAR DRISCOLL]|[plan_CHIRP] standard_charge|[payer_STAR DRISCOLL]|[plan_CHIRP]|methodology additional_payer_notes |[payer_STAR DRISCOLL]|[plan_CHIRP] standard_charge|[payer_STAR RIGHTCARE S&W]|[plan_ CHIRP]|negotiated_dollar standard_charge|[payer_STAR RIGHTCARE S&W]|[plan_ CHIRP]|negotiated_percentage standard_charge|[payer_STAR RIGHTCARE S&W]|[plan_ CHIRP]|negotiated_algorithm estimated_amount|[payer_STAR RIGHTCARE S&W]|[plan_ CHIRP] standard_charge|[payer_STAR RIGHTCARE S&W]|[plan_ CHIRP]|methodology additional_payer_notes |[payer_STAR RIGHTCARE S&W]|[plan_ CHIRP] 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 MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SUPERIOR MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SUPERIOR MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SUPERIOR MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_SUPERIOR MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SUPERIOR MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_SUREST]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SUREST]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SUREST]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SUREST]|[plan_HMO/PPO] standard_charge|[payer_SUREST]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SUREST]|[Plan_HMO/PPO] standard_charge|[payer_TEXAS CHILDREN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TEXAS CHILDREN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TEXAS CHILDREN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TEXAS CHILDREN]|[plan_MANAGED MEDICAID] standard_charge|[payer_TEXAS CHILDREN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TEXAS CHILDREN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TEXAS INDEPENDENCE HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_TEXAS INDEPENDENCE HEALTH]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_TEXAS INDEPENDENCE HEALTH]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_TEXAS INDEPENDENCE HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_TEXAS INDEPENDENCE HEALTH]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_TEXAS INDEPENDENCE HEALTH]|[Plan_MANAGED MEDICARE] standard_charge|[payer_TEXAS MUTUAL INSURANCE]|[plan_WORKERS COMP]|negotiated_dollar standard_charge|[payer_TEXAS MUTUAL INSURANCE]|[plan_WORKERS COMP] |negotiated_percentage standard_charge|[payer_TEXAS MUTUAL INSURANCE]|[plan_WORKERS COMP] |negotiated_algorithm estimated_amount|[payer_TEXAS MUTUAL INSURANCE]|[plan_WORKERS COMP] standard_charge|[payer_TEXAS MUTUAL INSURANCE]|[plan_WORKERS COMP] |methodology additional_payer_notes |[payer_TEXAS MUTUAL INSURANCE]|[Plan_WORKERS COMP] standard_charge|[payer_TEXOMA COMMUNITY CENTER]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TEXOMA COMMUNITY CENTER]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_TEXOMA COMMUNITY CENTER]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_TEXOMA COMMUNITY CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_TEXOMA COMMUNITY CENTER]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_TEXOMA COMMUNITY CENTER]|[Plan_LOCAL GOVT] standard_charge|[payer_TMHP]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_TMHP]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TMHP]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TMHP]|[plan_MEDICAID ] standard_charge|[payer_TMHP]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_TMHP]|[Plan_MEDICAID ] standard_charge|[payer_TML MULTISTATE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TML MULTISTATE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_TML MULTISTATE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_TML MULTISTATE]|[plan_HMO/PPO] standard_charge|[payer_TML MULTISTATE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_TML MULTISTATE]|[Plan_HMO/PPO] standard_charge|[payer_TRICARE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE]|[plan_TRICARE] standard_charge|[payer_TRICARE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE]|[Plan_TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE]|[plan_TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE FOR LIFE]|[Plan_TRICARE] standard_charge|[payer_TRICARE PRIME RETIRED]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE PRIME RETIRED]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE PRIME RETIRED]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE PRIME RETIRED]|[plan_TRICARE] standard_charge|[payer_TRICARE PRIME RETIRED]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE PRIME RETIRED]|[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]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRIWEST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRIWEST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRIWEST]|[plan_TRICARE] standard_charge|[payer_TRIWEST]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRIWEST]|[Plan_TRICARE] standard_charge|[payer_TRIWEST VA CCN]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_TRIWEST VA CCN]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_TRIWEST VA CCN]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_TRIWEST VA CCN]|[plan_VETERANS ADMIN] standard_charge|[payer_TRIWEST VA CCN]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_TRIWEST VA CCN]|[Plan_VETERANS ADMIN] standard_charge|[payer_TRS SCOTT AND WHITE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TRS SCOTT AND WHITE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_TRS SCOTT AND WHITE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_TRS SCOTT AND WHITE]|[plan_HMO/PPO] standard_charge|[payer_TRS SCOTT AND WHITE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_TRS SCOTT AND WHITE]|[Plan_HMO/PPO] standard_charge|[payer_UBH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UBH]|[plan_HMO/PPO] standard_charge|[payer_UBH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UBH]|[Plan_HMO/PPO] standard_charge|[payer_UCS BENVEO MULTIPLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UCS BENVEO MULTIPLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UCS BENVEO MULTIPLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UCS BENVEO MULTIPLAN]|[plan_HMO/PPO] standard_charge|[payer_UCS BENVEO MULTIPLAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UCS BENVEO MULTIPLAN]|[Plan_HMO/PPO] standard_charge|[payer_UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHC COMM STAR PLUS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC COMM STAR PLUS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_UHC GOLDEN RULE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC GOLDEN RULE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC GOLDEN RULE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC GOLDEN RULE]|[plan_HMO/PPO] standard_charge|[payer_UHC GOLDEN RULE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC GOLDEN RULE]|[Plan_HMO/PPO] standard_charge|[payer_UHC OPTIONS PPO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC OPTIONS PPO]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC OPTIONS PPO]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC OPTIONS PPO]|[plan_HMO/PPO] standard_charge|[payer_UHC OPTIONS PPO]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC OPTIONS PPO]|[Plan_HMO/PPO] standard_charge|[payer_UHC OXFORD]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC OXFORD]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC OXFORD]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC OXFORD]|[plan_HMO/PPO] standard_charge|[payer_UHC OXFORD]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC OXFORD]|[Plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC SHARED SERVICES]|[Plan_HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC STUDENT RESOURCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC STUDENT RESOURCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC STUDENT RESOURCE]|[plan_HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC STUDENT RESOURCE]|[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_UNITED HEALTH INTEGRATED]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTH INTEGRATED]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTH INTEGRATED]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH INTEGRATED]|[plan_HMO/PPO] standard_charge|[payer_UNITED HEALTH INTEGRATED]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTH INTEGRATED]|[Plan_HMO/PPO] standard_charge|[payer_US HEALTH AND LIFE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_US HEALTH AND LIFE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_US HEALTH AND LIFE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_US HEALTH AND LIFE]|[plan_HMO/PPO] standard_charge|[payer_US HEALTH AND LIFE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_US HEALTH AND LIFE]|[Plan_HMO/PPO] standard_charge|[payer_US HEALTH AND LIFE INS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_US HEALTH AND LIFE INS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_US HEALTH AND LIFE INS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_US HEALTH AND LIFE INS]|[plan_HMO/PPO] standard_charge|[payer_US HEALTH AND LIFE INS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_US HEALTH AND LIFE INS]|[Plan_HMO/PPO] standard_charge|[payer_USAA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_USAA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_USAA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_USAA]|[plan_HMO/PPO] standard_charge|[payer_USAA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_USAA]|[Plan_HMO/PPO] standard_charge|[payer_VA]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA]|[plan_VETERANS ADMIN] standard_charge|[payer_VA]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA]|[Plan_VETERANS ADMIN] standard_charge|[payer_VALUE OPTIONS MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_VALUE OPTIONS MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_VALUE OPTIONS MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_VALUE OPTIONS MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_VALUE OPTIONS MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_VALUE OPTIONS MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_WEB TPA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_WEB TPA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_WEB TPA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_WEB TPA]|[plan_HMO/PPO] standard_charge|[payer_WEB TPA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_WEB TPA]|[Plan_HMO/PPO] standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWALL]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE BY ALLWALL]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE BY ALLWALL]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE BY ALLWALL]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWALL]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE BY ALLWALL]|[Plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWELL]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE BY ALLWELL]|[Plan_MANAGED MEDICARE] standard_charge|[payer_WELLMED]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLMED]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLMED]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLMED]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLMED]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLMED]|[Plan_MANAGED MEDICARE] additional_generic_notes ROOM AND BOARD ACUTE PSYCH-ADOL 124 RC facility inpatient 2340 700 525 1651 962 per diem 530 per diem 934 per diem 743 per diem 700 per diem 700 per diem 700 per diem 700 per diem other drg 700 per diem 700 per diem 805 per diem 960 per diem 757 per diem 674 per diem 753 per diem 805 per diem 595 per diem 753 per diem 805 per diem 850 per diem 790 per diem 850 per diem 743 per diem 625 per diem 700 per diem 600 per diem 700 per diem other PSYCH DRG other PSYCH DRG 525 per diem other PSYCH DRG 900 per diem 900 per diem other PSYCH DRG other PSYCH DRG 530 per diem 530 per diem 950 per diem 600 per diem 960 per diem 650 per diem 794 per diem other PSYCH DRG 530 per diem 550 per diem 700 per diem 700 per diem 660 per diem 700 per diem 743 per diem 700 per diem 793 per diem 840 per diem 675 per diem 1012 per diem other PSYCH DRG 850 per diem 700 per diem 700 per diem 960 per diem other PSYCH DRG 855 per diem 650 per diem 650 per diem 700 per diem 780 per diem other PSYCH DRG 530 per diem other PSYCH DRG 530 per diem 783 per diem 700 per diem 700 per diem 700 per diem 700 per diem 700 per diem 600 per diem 700 per diem other PSYCH DRG 725 per diem 1651 per diem 1651 per diem 1104 per diem 911 per diem 1366 per diem 911 per diem 642 per diem other PSYCH DRG 700 per diem 530 per diem other PSYCH DRG 700 per diem 700 per diem 530 per diem 728 per diem 737 per diem 674 per diem 737 per diem 708 per diem 737 per diem 674 per diem 700 per diem 780 per diem 700 per diem 530 per diem 780 per diem 780 per diem 780 per diem 780 per diem 728 per diem 780 per diem 780 per diem 700 per diem 700 per diem 700 per diem 629 per diem other PSYCH DRG 700 per diem other PSYCH DRG other PSYCH DRG 700 per diem ROOM AND BOARD ACUTE DETOX 126 RC facility inpatient 2340 700 530 1651 962 per diem 530 per diem 934 per diem 743 per diem 700 per diem 700 per diem 700 per diem other drg 700 per diem 700 per diem 805 per diem 960 per diem 757 per diem 674 per diem 753 per diem 805 per diem 595 per diem 753 per diem 805 per diem 850 per diem 790 per diem 850 per diem 743 per diem 625 per diem 700 per diem 700 per diem other PSYCH DRG other PSYCH DRG 900 per diem 900 per diem 530 per diem 530 per diem 900 per diem 600 per diem 650 per diem 794 per diem other PSYCH DRG 530 per diem 550 per diem 700 per diem 700 per diem 660 per diem 700 per diem 743 per diem 700 per diem 793 per diem 840 per diem 675 per diem 1012 per diem other PSYCH DRG 700 per diem 700 per diem 960 per diem other PSYCH DRG 855 per diem 650 per diem 650 per diem 700 per diem 780 per diem other PSYCH DRG 530 per diem other PSYCH DRG 530 per diem 783 per diem 700 per diem 700 per diem 700 per diem 700 per diem 700 per diem 600 per diem 700 per diem other PSYCH DRG 1651 per diem 1651 per diem 1104 per diem 911 per diem 1366 per diem 911 per diem 642 per diem other PSYCH DRG 700 per diem 530 per diem other PSYCH DRG 700 per diem 700 per diem 530 per diem 728 per diem 737 per diem 674 per diem 737 per diem 708 per diem 737 per diem 674 per diem 700 per diem 780 per diem 700 per diem 530 per diem 780 per diem 780 per diem 780 per diem 780 per diem 728 per diem 780 per diem 780 per diem 700 per diem 700 per diem 629 per diem other PSYCH DRG other PSYCH DRG other PSYCH DRG 700 per diem BRIDGE ADOLESC PSYCH 513 RC facility inpatient 85 20 128 other drg 80 per diem 50 per diem 80 per diem 95 per diem 80 per diem 120 per diem 128 per diem 128 per diem 120 per diem 20 per diem 103 per diem 103 per diem 103 per diem 103 per diem 80 per diem 80 per diem 80 per diem 80 per diem 80 per diem BRIDGE ADULT PSYCH 513 RC facility inpatient 85 20 128 other drg 80 per diem 50 per diem 80 per diem 95 per diem 80 per diem 120 per diem 128 per diem 128 per diem 120 per diem 20 per diem 103 per diem 103 per diem 103 per diem 103 per diem 80 per diem 80 per diem 80 per diem 80 per diem 80 per diem BRIDGE CHILD PSYCH 513 RC facility inpatient 85 20 128 other drg 80 per diem 50 per diem 80 per diem 95 per diem 80 per diem 120 per diem 128 per diem 128 per diem 120 per diem 20 per diem 103 per diem 103 per diem 103 per diem 103 per diem 80 per diem 80 per diem 80 per diem 80 per diem 80 per diem BRIDGE DETOX ADULT 513 RC facility inpatient 85 20 128 other drg 80 per diem 50 per diem 80 per diem 95 per diem 80 per diem 120 per diem 128 per diem 128 per diem 120 per diem 20 per diem 103 per diem 103 per diem 103 per diem 103 per diem 80 per diem 80 per diem 80 per diem 80 per diem 80 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADULT 905 RC facility outpatient 778 210 106 378 181 per diem 225 per diem 218 per diem 200 per diem 165 per diem other drg 240 per diem 338 per diem 216 per diem 228 per diem 240 per diem 228 per diem 240 per diem 210 per diem 378 per diem 208 per diem 150 per diem 275 per diem 338 per diem 152 per diem 181 per diem 130 per diem 210 per diem 292 per diem 338 per diem 150 per diem 210 per diem 210 per diem 125 per diem 106 per diem 150 per diem 210 per diem 210 per diem 210 per diem 152 per diem 210 per diem 210 per diem 181 per diem TH INTENSIVE OUTPATIENT PROGRAM PSYCH ADULT 905 RC facility outpatient 778 210 106 378 181 per diem 225 per diem 218 per diem 200 per diem 165 per diem other drg 240 per diem 338 per diem 216 per diem 228 per diem 240 per diem 228 per diem 240 per diem 210 per diem 378 per diem 208 per diem 150 per diem 275 per diem 338 per diem 152 per diem 181 per diem 130 per diem 210 per diem 292 per diem 338 per diem 150 per diem 210 per diem 210 per diem 125 per diem 106 per diem 150 per diem 210 per diem 210 per diem 210 per diem 152 per diem 210 per diem 210 per diem 181 per diem INTENSIVE OUTPATIENT PROGRAM CD ADULT 906 RC facility outpatient 778 210 106 378 181 per diem 225 per diem 218 per diem 200 per diem 165 per diem other drg 281 per diem 338 per diem 270 per diem 228 per diem 281 per diem 228 per diem 281 per diem 378 per diem 208 per diem 150 per diem 275 per diem 338 per diem 152 per diem 181 per diem 338 per diem 150 per diem 125 per diem 106 per diem 150 per diem 210 per diem 210 per diem 210 per diem 152 per diem 210 per diem 210 per diem 181 per diem TELEH INTENSIVE OUTPATIENT PROGRAM CD ADULT 906 RC facility outpatient 778 210 106 378 181 per diem 225 per diem 218 per diem 200 per diem 165 per diem other drg 281 per diem 338 per diem 270 per diem 228 per diem 281 per diem 228 per diem 281 per diem 378 per diem 208 per diem 150 per diem 275 per diem 338 per diem 152 per diem 181 per diem 338 per diem 150 per diem 125 per diem 106 per diem 150 per diem 210 per diem 210 per diem 210 per diem 152 per diem 210 per diem 210 per diem 181 per diem PARTIAL HOSPITAL PROGRAM ADOLESCENT PYSCH 912 RC facility outpatient 1170 350 125 585 210 per diem 450 per diem 230 per diem 275 per diem 225 per diem 350 per diem other drg 350 per diem 450 per diem 486 per diem 450 per diem 428 per diem 450 per diem 267 per diem 450 per diem 350 per diem 585 per diem 339 per diem 300 per diem 400 per diem 486 per diem 175 per diem 210 per diem 150 per diem 350 per diem 551 per diem 486 per diem 350 per diem 350 per diem 242 per diem 210 per diem 185 per diem 241 per diem 125 per diem 350 per diem 350 per diem 350 per diem 242 per diem 175 per diem 242 per diem 350 per diem 350 per diem 210 per diem PARTIAL HOSPITAL PROGRAM PSYCH 912 RC facility outpatient 1135 350 125 585 210 per diem 450 per diem 230 per diem 275 per diem 225 per diem 350 per diem other drg 350 per diem 450 per diem 486 per diem 450 per diem 428 per diem 450 per diem 267 per diem 450 per diem 350 per diem 585 per diem 339 per diem 300 per diem 400 per diem 486 per diem 175 per diem 210 per diem 150 per diem 350 per diem 551 per diem 486 per diem 350 per diem 350 per diem 242 per diem 210 per diem 185 per diem 241 per diem 125 per diem 350 per diem 350 per diem 350 per diem 242 per diem 175 per diem 242 per diem 350 per diem 350 per diem 210 per diem TELEH PARTIAL HOSPITAL PROGRAM CD ADULTS 912 RC facility outpatient 1170 350 125 585 210 per diem 450 per diem 230 per diem 275 per diem 225 per diem 350 per diem other drg 350 per diem 450 per diem 486 per diem 450 per diem 428 per diem 450 per diem 267 per diem 450 per diem 350 per diem 585 per diem 339 per diem 300 per diem 400 per diem 486 per diem 175 per diem 210 per diem 150 per diem 350 per diem 551 per diem 486 per diem 350 per diem 350 per diem 242 per diem 210 per diem 185 per diem 241 per diem 125 per diem 350 per diem 350 per diem 350 per diem 242 per diem 175 per diem 242 per diem 350 per diem 350 per diem 210 per diem TH PARTIAL HOSPITAL PROGRAM ADOLESCENTS 912 RC facility outpatient 1170 350 125 585 210 per diem 450 per diem 230 per diem 275 per diem 225 per diem 350 per diem other drg 350 per diem 450 per diem 486 per diem 450 per diem 428 per diem 450 per diem 267 per diem 450 per diem 350 per diem 585 per diem 339 per diem 300 per diem 400 per diem 486 per diem 175 per diem 210 per diem 150 per diem 350 per diem 551 per diem 486 per diem 350 per diem 350 per diem 242 per diem 210 per diem 185 per diem 241 per diem 125 per diem 350 per diem 350 per diem 350 per diem 242 per diem 175 per diem 242 per diem 350 per diem 350 per diem 210 per diem TH PARTIAL HOSPITAL PROGRAM MH ADULT 912 RC facility outpatient 1170 350 125 585 210 per diem 450 per diem 230 per diem 275 per diem 225 per diem 350 per diem other drg 350 per diem 450 per diem 486 per diem 450 per diem 428 per diem 450 per diem 267 per diem 450 per diem 350 per diem 585 per diem 339 per diem 300 per diem 400 per diem 486 per diem 175 per diem 210 per diem 150 per diem 350 per diem 551 per diem 486 per diem 350 per diem 350 per diem 242 per diem 210 per diem 185 per diem 241 per diem 125 per diem 350 per diem 350 per diem 350 per diem 242 per diem 175 per diem 242 per diem 350 per diem 350 per diem 210 per diem INTENSIVE OUTPATIENT PROGRAM ADOL GROUP 915 RC facility outpatient 259 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem INTENSIVE OUTPATIENT PROGRAM CD PROC GRP 1 915 RC facility outpatient 275 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem INTENSIVE OUTPATIENT PROGRAM MCR PSY PROC 3 915 RC facility outpatient 228 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem PARTIAL HOSPITAL PROGRAM ADOL GROUP 915 RC facility outpatient 1170 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem PARTIAL HOSPITAL PROGRAM CD MCR PRC GRP 1 915 RC facility outpatient 325 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem TH INTENSIVE OUTPATIENT PROGRAM CD PROC GP 2 915 RC facility outpatient 275 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem TH INTENSIVE OUTPATIENT PROGRAM MCR PSY PRC 1 915 RC facility outpatient 275 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem TH INTENSIVE OUTPATIENT PROGRAM PROCESS GRP 1 915 RC facility outpatient 275 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem TH PARTIAL HOSPITAL PROGRAM CD MRC PROC 3 915 RC facility outpatient 325 80 140 450 437 per diem other drg 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem TH PARTIAL HOSPITAL PROGRAM MH PROC GRP 1 915 RC facility outpatient 325 80 140 450 437 per diem 450 per diem 229 per diem 140 per diem 350 per diem 350 per diem 152 per diem 90792 Initial Eval - With Medical 310.00 90792 RC facility both 310 129 231 145 fee schedule 231 fee schedule 138 fee schedule 227 fee schedule 227 fee schedule 147 fee schedule 147 fee schedule 132 fee schedule 172 fee schedule 155 fee schedule 129 fee schedule 154 fee schedule 142 fee schedule 130 fee schedule 145 fee schedule 99231 Subseq Care (15 Min) 120.00 99231 RC facility both 120 35 141 141 fee schedule 50 fee schedule 70 fee schedule 41 fee schedule 41 fee schedule 70 fee schedule 45 fee schedule 45 fee schedule 70 fee schedule 48 fee schedule 92 fee schedule 47 fee schedule 70 fee schedule 35 fee schedule 38 fee schedule 99232 Subseq Care (25 Min) 140.00 99232 RC facility both 140 76 76 76 fee schedule 76 fee schedule 99238 Discharge Day Mgmt <30 Min 160.00 99238 RC facility both 160 61 112 95 fee schedule 81 fee schedule 61 fee schedule 112 fee schedule 112 fee schedule 65 fee schedule 95 fee schedule 80 fee schedule