hospital_name last_updated_on version hospital_location hospital_address license_number|TX "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." "Red River Hospital, LLC" 5/31/2024 2.0.0 "Wichata Fall,Texas " 1505 Eighth Street license_008749 | 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_AETNA HEALTH PLANS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA HEALTH PLANS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_AETNA HEALTH PLANS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_AETNA HEALTH PLANS]|[plan_HMO/PPO] standard_charge|[payer_AETNA HEALTH PLANS]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_AETNA HEALTH PLANS]|[plan_HMO/PPO] 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_ALLIED]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALLIED]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_ALLIED]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_ALLIED]|[plan_HMO/PPO] standard_charge|[payer_ALLIED]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_ALLIED]|[plan_HMO/PPO] standard_charge|[payer_ALLWELL BY SUPERIOR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALLWELL BY SUPERIOR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_ALLWELL BY SUPERIOR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_ALLWELL BY SUPERIOR]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL BY SUPERIOR]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_ALLWELL BY SUPERIOR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMERICAN HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AMERICAN HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_AMERICAN HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_AMERICAN HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_AMERICAN HEALTH PLAN]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_AMERICAN HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_dollar standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_percentage standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_algorithm estimated_amount|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID UNDER 21]|methodology additional_payer_notes|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID 22-64]|negotiated_dollar standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID 22-64]|negotiated_percentage standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID 22-64]|negotiated_algorithm estimated_amount|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID 22-64] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID 22-64]|methodology additional_payer_notes|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID 22-64] 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 MANAGED MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS MANAGED MCR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_BCBS MANAGED MCR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_BCBS MANAGED MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS MANAGED MCR]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_BCBS MANAGED MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS TEXAS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS TEXAS]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS TEXAS]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS]|[plan_BLUE CROSS]|methodology additional_payer_notes|[payer_BCBS TEXAS]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS HEALTH SELECT]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TEXAS HEALTH SELECT]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS TEXAS HEALTH SELECT]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS TEXAS HEALTH SELECT]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TEXAS HEALTH SELECT]|[plan_BLUE CROSS]|methodology additional_payer_notes|[payer_BCBS TEXAS HEALTH SELECT]|[plan_BLUE CROSS] standard_charge|[payer_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_BETTY HARDWICK MHMR]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BETTY HARDWICK MHMR]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_BETTY HARDWICK MHMR]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_BETTY HARDWICK MHMR]|[plan_LOCAL GOVT] standard_charge|[payer_BETTY HARDWICK MHMR]|[plan_LOCAL GOVT]|methodology additional_payer_notes|[payer_BETTY HARDWICK MHMR]|[plan_LOCAL GOVT] standard_charge|[payer_CARE IMPROV PLUS MCR REPL]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARE IMPROV PLUS MCR REPL]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_CARE IMPROV PLUS MCR REPL]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_CARE IMPROV PLUS MCR REPL]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARE IMPROV PLUS MCR REPL]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_CARE IMPROV PLUS MCR REPL]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_CARE IMPROVEMENT PLUS]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT PLUS]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_CARE IMPROVEMENT PLUS]|[plan_MANAGED MEDICARE] standard_charge|[payer_CENPATICO]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CENPATICO]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_CENPATICO]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_CENPATICO]|[plan_MANAGED MEDICAID] standard_charge|[payer_CENPATICO]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes|[payer_CENPATICO]|[plan_MANAGED MEDICAID] standard_charge|[payer_CENPATICO *DO NOT USE*]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CENPATICO *DO NOT USE*]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_CENPATICO *DO NOT USE*]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_CENPATICO *DO NOT USE*]|[plan_MANAGED MEDICAID] standard_charge|[payer_CENPATICO *DO NOT USE*]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes|[payer_CENPATICO *DO NOT USE*]|[plan_MANAGED MEDICAID] 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_CHARITY]|[plan_SELF PAY CHARITY]|negotiated_dollar standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY]|negotiated_percentage standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY]|negotiated_algorithm estimated_amount|[payer_CHARITY]|[plan_SELF PAY CHARITY] standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY]|methodology additional_payer_notes|[payer_CHARITY]|[plan_SELF PAY CHARITY] standard_charge|[payer_CIGNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_CIGNA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CIGNA]|[plan_HMO/PPO] standard_charge|[payer_CIGNA]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_CIGNA]|[plan_HMO/PPO] standard_charge|[payer_CIGNA HEALTH SPRINGS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CIGNA HEALTH SPRINGS]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_CIGNA HEALTH SPRINGS]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_CIGNA HEALTH SPRINGS]|[plan_MANAGED MEDICAID] standard_charge|[payer_CIGNA HEALTH SPRINGS]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes|[payer_CIGNA HEALTH SPRINGS]|[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_COOKS CHILDRENS HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COOKS CHILDRENS HEALTH]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_COOKS CHILDRENS HEALTH]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_COOKS CHILDRENS HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_COOKS CHILDRENS HEALTH]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes|[payer_COOKS CHILDRENS HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_DENTON COUNTY MHMR]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DENTON COUNTY MHMR]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_DENTON COUNTY MHMR]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_DENTON COUNTY MHMR]|[plan_LOCAL GOVT] standard_charge|[payer_DENTON COUNTY MHMR]|[plan_LOCAL GOVT]|methodology additional_payer_notes|[payer_DENTON COUNTY MHMR]|[plan_LOCAL GOVT] standard_charge|[payer_EMI HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_EMI HEALTH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_EMI HEALTH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_EMI HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_EMI HEALTH]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_EMI HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_dollar standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_percentage standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_algorithm estimated_amount|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|methodology additional_payer_notes|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|negotiated_dollar standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|negotiated_percentage standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|negotiated_algorithm estimated_amount|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64] standard_charge|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|methodology additional_payer_notes|[payer_FIRST CARE HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64] standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_GEHA]|[plan_COMMERCIAL] standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_GEHA]|[plan_COMMERCIAL] standard_charge|[payer_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_GREAT WEST]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_GREAT WEST]|[plan_HMO/PPO] standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_GREAT WEST]|[plan_HMO/PPO] standard_charge|[payer_GROUP RESOURCES]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GROUP RESOURCES]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_GROUP RESOURCES]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_GROUP RESOURCES]|[plan_COMMERCIAL] standard_charge|[payer_GROUP RESOURCES]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_GROUP RESOURCES]|[plan_COMMERCIAL] standard_charge|[payer_HAWAII MAINLAND ADMIN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HAWAII MAINLAND ADMIN]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_HAWAII MAINLAND ADMIN]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_HAWAII MAINLAND ADMIN]|[plan_COMMERCIAL] standard_charge|[payer_HAWAII MAINLAND ADMIN]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_HAWAII MAINLAND ADMIN]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH CHOICE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH CHOICE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTH CHOICE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTH CHOICE]|[plan_HMO/PPO] standard_charge|[payer_HEALTH CHOICE]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_HEALTH CHOICE]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTHSMART]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_HEALTHSMART]|[plan_HMO/PPO] standard_charge|[payer_HELEN FARABEE]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_HELEN FARABEE]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_HELEN FARABEE]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_HELEN FARABEE]|[plan_LOCAL GOVT] standard_charge|[payer_HELEN FARABEE]|[plan_LOCAL GOVT]|methodology additional_payer_notes|[payer_HELEN FARABEE]|[plan_LOCAL GOVT] standard_charge|[payer_HUMANA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_HUMANA]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_COMMERCIAL] standard_charge|[payer_HUMANA]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_HUMANA]|[plan_COMMERCIAL] 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]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_HUMANA]|[plan_MANAGED MEDICARE] standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO] standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO] standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO PHYSICIAN]|negotiated_percentage standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO PHYSICIAN]|negotiated_algorithm estimated_amount|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO PHYSICIAN] standard_charge|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO PHYSICIAN]|methodology additional_payer_notes|[payer_INDIAN HEALTH SERVICES]|[plan_HMO/PPO PHYSICIAN] standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_KEMPTON GROUP]|[plan_COMMERCIAL] standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_KEMPTON GROUP]|[plan_COMMERCIAL] standard_charge|[payer_LIFE SYNCH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_LIFE SYNCH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_LIFE SYNCH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_LIFE SYNCH]|[plan_COMMERCIAL] standard_charge|[payer_LIFE SYNCH]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_LIFE SYNCH]|[plan_COMMERCIAL] standard_charge|[payer_MAGELLAN BEHAVIORAL HEAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN BEHAVIORAL HEAL]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MAGELLAN BEHAVIORAL HEAL]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MAGELLAN BEHAVIORAL HEAL]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN BEHAVIORAL HEAL]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_MAGELLAN BEHAVIORAL HEAL]|[plan_HMO/PPO] standard_charge|[payer_MAIL HANDLERS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAIL HANDLERS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MAIL HANDLERS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MAIL HANDLERS]|[plan_HMO/PPO] standard_charge|[payer_MAIL HANDLERS]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_MAIL HANDLERS]|[plan_HMO/PPO] standard_charge|[payer_MAIL HANDLERS BEN PLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAIL HANDLERS BEN PLAN]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MAIL HANDLERS BEN PLAN]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MAIL HANDLERS BEN PLAN]|[plan_HMO/PPO] standard_charge|[payer_MAIL HANDLERS BEN PLAN]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_MAIL HANDLERS BEN PLAN]|[plan_HMO/PPO] standard_charge|[payer_MEDICAID NHIC]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_MEDICAID NHIC]|[plan_MEDICAID]|negotiated_percentage standard_charge|[payer_MEDICAID NHIC]|[plan_MEDICAID]|negotiated_algorithm estimated_amount|[payer_MEDICAID NHIC]|[plan_MEDICAID] standard_charge|[payer_MEDICAID NHIC]|[plan_MEDICAID]|methodology additional_payer_notes|[payer_MEDICAID NHIC]|[plan_MEDICAID] standard_charge|[payer_MEDICARE TX]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE TX]|[plan_MEDICARE]|negotiated_percentage standard_charge|[payer_MEDICARE TX]|[plan_MEDICARE]|negotiated_algorithm estimated_amount|[payer_MEDICARE TX]|[plan_MEDICARE] standard_charge|[payer_MEDICARE TX]|[plan_MEDICARE]|methodology additional_payer_notes|[payer_MEDICARE TX]|[plan_MEDICARE] standard_charge|[payer_MENTAL HEALTH NETWORK]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MENTAL HEALTH NETWORK]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MENTAL HEALTH NETWORK]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MENTAL HEALTH NETWORK]|[plan_HMO/PPO] standard_charge|[payer_MENTAL HEALTH NETWORK]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_MENTAL HEALTH NETWORK]|[plan_HMO/PPO] standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_MISC INSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL]|methodology additional_payer_notes|[payer_MISC INSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID UNDER 21]|methodology additional_payer_notes|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID 22-64]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID 22-64]|negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID 22-64]|negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID 22-64] standard_charge|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID 22-64]|methodology additional_payer_notes|[payer_MOLINA HEALTHCARE]|[plan_MANAGED MEDICAID 22-64] standard_charge|[payer_OKLAHOMA HEALTH CARE AUTH]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_OKLAHOMA HEALTH CARE AUTH]|[plan_MEDICAID]|negotiated_percentage standard_charge|[payer_OKLAHOMA HEALTH CARE AUTH]|[plan_MEDICAID]|negotiated_algorithm estimated_amount|[payer_OKLAHOMA HEALTH CARE AUTH]|[plan_MEDICAID] standard_charge|[payer_OKLAHOMA HEALTH CARE AUTH]|[plan_MEDICAID]|methodology additional_payer_notes|[payer_OKLAHOMA HEALTH CARE AUTH]|[plan_MEDICAID] standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_OPTUM HEALTH]|[plan_HMO/PPO] standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_OPTUM HEALTH]|[plan_HMO/PPO] standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_PECAN VALLEY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_PECAN VALLEY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_PECAN VALLEY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_PECAN VALLEY]|[plan_LOCAL GOVT] standard_charge|[payer_PECAN VALLEY]|[plan_LOCAL GOVT]|methodology additional_payer_notes|[payer_PECAN VALLEY]|[plan_LOCAL GOVT] standard_charge|[payer_REGENCE BLUE SHIELD]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_REGENCE BLUE SHIELD]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_REGENCE BLUE SHIELD]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_REGENCE BLUE SHIELD]|[plan_BLUE CROSS] standard_charge|[payer_REGENCE BLUE SHIELD]|[plan_BLUE CROSS]|methodology additional_payer_notes|[payer_REGENCE BLUE SHIELD]|[plan_BLUE CROSS] standard_charge|[payer_SECURE HORIZONS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SECURE HORIZONS]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_SECURE HORIZONS]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_SECURE HORIZONS]|[plan_MANAGED MEDICARE] standard_charge|[payer_SECURE HORIZONS]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes|[payer_SECURE HORIZONS]|[plan_MANAGED MEDICARE] standard_charge|[payer_STARCARE SPECIALTY HEALTH]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_STARCARE SPECIALTY HEALTH]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_STARCARE SPECIALTY HEALTH]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_STARCARE SPECIALTY HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_STARCARE SPECIALTY HEALTH]|[plan_LOCAL GOVT]|methodology additional_payer_notes|[payer_STARCARE SPECIALTY HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_dollar standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_percentage standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|negotiated_algorithm estimated_amount|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21]|methodology additional_payer_notes|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID UNDER 21] standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|negotiated_dollar standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|negotiated_percentage standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|negotiated_algorithm estimated_amount|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64] standard_charge|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64]|methodology additional_payer_notes|[payer_SUPERIOR HEALTH PLAN]|[plan_MANAGED MEDICAID 22-64] 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_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_TML INTERGOVERNMENTAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TML INTERGOVERNMENTAL]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_TML INTERGOVERNMENTAL]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_TML INTERGOVERNMENTAL]|[plan_HMO/PPO] standard_charge|[payer_TML INTERGOVERNMENTAL]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_TML INTERGOVERNMENTAL]|[plan_HMO/PPO] 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 EAST ACTIVE DUTY]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST ACTIVE DUTY]|[plan_TRICARE]|negotiated_percentage standard_charge|[payer_TRICARE EAST ACTIVE DUTY]|[plan_TRICARE]|negotiated_algorithm estimated_amount|[payer_TRICARE EAST ACTIVE DUTY]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST ACTIVE DUTY]|[plan_TRICARE]|methodology additional_payer_notes|[payer_TRICARE EAST ACTIVE DUTY]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST DEPENDENT]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST DEPENDENT]|[plan_TRICARE]|negotiated_percentage standard_charge|[payer_TRICARE EAST DEPENDENT]|[plan_TRICARE]|negotiated_algorithm estimated_amount|[payer_TRICARE EAST DEPENDENT]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST DEPENDENT]|[plan_TRICARE]|methodology additional_payer_notes|[payer_TRICARE EAST DEPENDENT]|[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 FOR LIFE]|[plan_TRICARE PHYSICIAN]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE PHYSICIAN]|negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE PHYSICIAN]|negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE]|[plan_TRICARE PHYSICIAN] standard_charge|[payer_TRICARE FOR LIFE]|[plan_TRICARE PHYSICIAN]|methodology additional_payer_notes|[payer_TRICARE FOR LIFE]|[plan_TRICARE PHYSICIAN] standard_charge|[payer_TRICARE NORTH REGION]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE NORTH REGION]|[plan_TRICARE]|negotiated_percentage standard_charge|[payer_TRICARE NORTH REGION]|[plan_TRICARE]|negotiated_algorithm estimated_amount|[payer_TRICARE NORTH REGION]|[plan_TRICARE] standard_charge|[payer_TRICARE NORTH REGION]|[plan_TRICARE]|methodology additional_payer_notes|[payer_TRICARE NORTH REGION]|[plan_TRICARE] standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE]|negotiated_percentage standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE]|negotiated_algorithm estimated_amount|[payer_TRICARE OVERSEAS]|[plan_TRICARE] standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE]|methodology additional_payer_notes|[payer_TRICARE OVERSEAS]|[plan_TRICARE] standard_charge|[payer_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 VA CCN CLAIMS]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_TRIWEST VA CCN CLAIMS]|[plan_VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_TRIWEST VA CCN CLAIMS]|[plan_VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_TRIWEST VA CCN CLAIMS]|[plan_VETERANS ADMIN] standard_charge|[payer_TRIWEST VA CCN CLAIMS]|[plan_VETERANS ADMIN]|methodology additional_payer_notes|[payer_TRIWEST VA CCN CLAIMS]|[plan_VETERANS ADMIN] standard_charge|[payer_TX DFPS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TX DFPS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_TX DFPS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_TX DFPS]|[plan_LOCAL GOVT] standard_charge|[payer_TX DFPS]|[plan_LOCAL GOVT]|methodology additional_payer_notes|[payer_TX DFPS]|[plan_LOCAL GOVT] standard_charge|[payer_UBH MANAGED MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UBH MANAGED MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UBH MANAGED MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UBH MANAGED MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_UBH MANAGED MEDICAID]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes|[payer_UBH MANAGED MEDICAID]|[plan_MANAGED MEDICAID] 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 BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_VHA OFFICE OF COMMUNITY]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VHA OFFICE OF COMMUNITY]|[plan_VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_VHA OFFICE OF COMMUNITY]|[plan_VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_VHA OFFICE OF COMMUNITY]|[plan_VETERANS ADMIN] standard_charge|[payer_VHA OFFICE OF COMMUNITY]|[plan_VETERANS ADMIN]|methodology additional_payer_notes|[payer_VHA OFFICE OF COMMUNITY]|[plan_VETERANS ADMIN] standard_charge|[payer_WEB TPA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_WEB TPA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_WEB TPA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_WEB TPA]|[plan_HMO/PPO] standard_charge|[payer_WEB TPA]|[plan_HMO/PPO]|methodology additional_payer_notes|[payer_WEB TPA]|[plan_HMO/PPO] standard_charge|[payer_WELLCARE]|[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] additional_generic_notes ADOL ROOM & BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 724 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem ADULT ROOM & BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 724 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem CHILD ROOM & BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 724 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem GERIACTRICATRIC ROOM & BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 724 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem MILITARY ROOM & BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 724 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem PICU ROOM AND BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 724 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem SUBACUT ROOM & BOARD 124 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 1072.44 per diem 782.8 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 498 per diem 550 per diem 675 per diem 683.07 per diem 498.59 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 575 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 650 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 842.55 per diem 615 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 850 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem ADULT CD-DETOX/2 BED 126 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem ADULT DETOX ROOM & BOARD 126 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem GERIACTRIC CD-DETOX/2 BED 126 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem MILIT CD-DETOX/2 BED 126 RC facility Inpatient 2060 675 400 1090 750 per diem 694 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 565 per diem 694 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem 700 per diem ADULT CD/REHAB/2BED 128 RC facility Inpatient 2060 675 400 1090 750 per diem 627 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 515 per diem 627 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem ADULT REHAB R&B 128 RC facility Inpatient 2060 675 400 1090 750 per diem 627 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 515 per diem 627 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem GERIACTRIC CD/REHAB/2 BED 128 RC facility Inpatient 2060 675 400 1090 750 per diem 627 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 515 per diem 627 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem MILIT CD/REHAB/2BED 128 RC facility Inpatient 2060 675 400 1090 750 per diem 627 per diem 675 per diem 675 per diem 675 per diem 805 per diem 760 per diem 805 per diem 753 per diem 754 per diem 635 per diem 725 per diem 725 per diem 550 per diem 590 per diem 675 per diem 782 per diem 498 per diem 400 per diem 550 per diem 675 per diem 725 per diem 782 per diem 754 per diem 700 per diem 675 per diem 754 per diem 530 per diem 700 per diem 624 per diem 652 per diem 652 per diem 782 per diem 624 per diem 725 per diem 725 per diem 498 per diem 869 other DRG 515 per diem 627 per diem 675 per diem 799 per diem 650 per diem 596 per diem 725 per diem 725 per diem 660 per diem 760 per diem 725 per diem 700 per diem 700 per diem 725 per diem 1035 per diem 1035 per diem 869 per diem 869 per diem 962 per diem 1090 per diem 725 per diem 769 per diem 725 per diem 869 other DRG 514 per diem INTENSIVE OUTPATIENT PROGRAM ADOL 905 RC facility Outpatient 525 150 125 450 195 per diem 240 per diem 240 per diem 228 per diem 450 per diem 165 per diem 320 per diem 125 per diem 191 per diem 125 per diem 150 per diem 134 per diem 191 per diem 150 per diem 125 per diem 173 per diem 246 per diem 191 per diem 150 per diem 156 per diem 161 per diem 175 per diem 175 per diem 165 per diem 134 per diem 134 per diem 165 per diem 246 per diem 173 per diem 173 per diem 246 per diem 160 per diem 160 per diem 165 per diem 390 per diem 165 per diem INTENSIVE OUTPATIENT PROGRAM ADULT 905 RC facility Outpatient 525 150 125 450 195 per diem 240 per diem 240 per diem 228 per diem 450 per diem 165 per diem 320 per diem 125 per diem 191 per diem 125 per diem 150 per diem 134 per diem 191 per diem 150 per diem 125 per diem 173 per diem 246 per diem 191 per diem 150 per diem 156 per diem 161 per diem 175 per diem 175 per diem 165 per diem 134 per diem 134 per diem 165 per diem 246 per diem 173 per diem 173 per diem 246 per diem 160 per diem 160 per diem 165 per diem 390 per diem 165 per diem INTENSIVE OUTPATIENT PROGRAM CD 906 RC facility Outpatient 350 150 125 450 281 per diem 281 per diem 450 per diem 165 per diem 320 per diem 125 per diem 191 per diem 134 per diem 191 per diem 150 per diem 125 per diem 173 per diem 246 per diem 191 per diem 150 per diem 156 per diem 175 per diem 175 per diem 165 per diem 134 per diem 134 per diem 165 per diem 246 per diem 173 per diem 173 per diem 246 per diem 160 per diem 165 per diem 165 per diem PARTIAL HOSPITAL PROGRAM ADULT CD 912 RC facility Outpatient 550 250 189 864 378 per diem 450 per diem 450 per diem 428 per diem 864 per diem 310 per diem 620 per diem 250 per diem 310 per diem 250 per diem 250 per diem 268 per diem 329 per diem 250 per diem 235 per diem 189 per diem 246 per diem 329 per diem 250 per diem 312 per diem 246 per diem 311 per diem 350 per diem 350 per diem 310 per diem 268 per diem 268 per diem 310 per diem 246 per diem 246 per diem 189 per diem 193 per diem 246 per diem 246 per diem 310 per diem 310 per diem 310 per diem 202 per diem 756 per diem 275 per diem PARTIAL HOSPITAL PROGRAM ADULT FULL DAY 912 RC facility Outpatient 824 250 189 864 378 per diem 450 per diem 450 per diem 428 per diem 864 per diem 310 per diem 620 per diem 250 per diem 310 per diem 250 per diem 250 per diem 268 per diem 329 per diem 250 per diem 235 per diem 189 per diem 246 per diem 329 per diem 250 per diem 312 per diem 246 per diem 311 per diem 350 per diem 350 per diem 310 per diem 268 per diem 268 per diem 310 per diem 246 per diem 246 per diem 189 per diem 193 per diem 246 per diem 246 per diem 310 per diem 310 per diem 310 per diem 202 per diem 756 per diem 275 per diem PARTIAL HOSPITAL PROGRAM GERIACTRICATRIC 912 RC facility Outpatient 550 250 189 864 378 per diem 450 per diem 450 per diem 428 per diem 864 per diem 310 per diem 620 per diem 250 per diem 310 per diem 250 per diem 250 per diem 268 per diem 329 per diem 250 per diem 235 per diem 189 per diem 246 per diem 329 per diem 250 per diem 312 per diem 246 per diem 311 per diem 350 per diem 350 per diem 310 per diem 268 per diem 268 per diem 310 per diem 246 per diem 246 per diem 189 per diem 193 per diem 246 per diem 246 per diem 310 per diem 310 per diem 310 per diem 202 per diem 756 per diem 275 per diem