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." "El Paso Behavioral Hosptial, LLC" 5/31/2024 2.0.0 "El Paso, Texas" 1390 Northwestern Drive license_100456 | 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_AARP SUPPLEMENTAL HEALTH]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_AARP SUPPLEMENTAL HEALTH]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_AARP SUPPLEMENTAL HEALTH]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AARP SUPPLEMENTAL HEALTH]|[plan_ COMMERCIAL] standard_charge|[payer_AARP SUPPLEMENTAL HEALTH]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_AARP SUPPLEMENTAL HEALTH]|[Plan_ COMMERCIAL] standard_charge|[payer_AETNA HEALTHCARE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA HEALTHCARE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA HEALTHCARE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA HEALTHCARE]|[plan_ HMO/PPO] standard_charge|[payer_AETNA HEALTHCARE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_AETNA HEALTHCARE]|[Plan_ HMO/PPO] standard_charge|[payer_AETNA LIFE INSURANCE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA LIFE INSURANCE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA LIFE INSURANCE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA LIFE INSURANCE]|[plan_ HMO/PPO] standard_charge|[payer_AETNA LIFE INSURANCE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_AETNA LIFE INSURANCE]|[Plan_ HMO/PPO] standard_charge|[payer_AETNA MEDICARE MNGD]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE MNGD]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE MNGD]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE MNGD]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE MNGD]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE MNGD]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_ COMMERCIAL] standard_charge|[payer_AETNA SENIOR SUPPLEMENTAL]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_AETNA SENIOR SUPPLEMENTAL]|[Plan_ COMMERCIAL] standard_charge|[payer_ALLIED BENEFITS SYSTEMS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALLIED BENEFITS SYSTEMS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLIED BENEFITS SYSTEMS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLIED BENEFITS SYSTEMS]|[plan_ COMMERCIAL] standard_charge|[payer_ALLIED BENEFITS SYSTEMS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_ALLIED BENEFITS SYSTEMS]|[Plan_ COMMERCIAL] standard_charge|[payer_ALLWELL]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALLWELL]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALLWELL]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALLWELL]|[plan_ MANAGED MEDICARE] standard_charge|[payer_ALLWELL]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ALLWELL]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP DUAL]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIGROUP DUAL]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIGROUP DUAL]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP DUAL]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP DUAL]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIGROUP DUAL]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP MCD]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP MCD]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP MCD]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP MCD]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP MCD]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP MCD]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP STAR]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP STAR]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP STAR PLUS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP STAR PLUS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP STAR PLUS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP STAR PLUS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_ARIZONA COMPLETE HEALTH]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ARIZONA COMPLETE HEALTH]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ARIZONA COMPLETE HEALTH]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ARIZONA COMPLETE HEALTH]|[plan_ MANAGED MEDICAID] standard_charge|[payer_ARIZONA COMPLETE HEALTH]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ARIZONA COMPLETE HEALTH]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_ASR HEALTH BENEFITS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_ASR HEALTH BENEFITS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_ASR HEALTH BENEFITS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ASR HEALTH BENEFITS]|[plan_ COMMERCIAL] standard_charge|[payer_ASR HEALTH BENEFITS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_ASR HEALTH BENEFITS]|[Plan_ COMMERCIAL] standard_charge|[payer_ASSURED BENEFITS ADMIN]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_ASSURED BENEFITS ADMIN]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_ASSURED BENEFITS ADMIN]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ASSURED BENEFITS ADMIN]|[plan_ COMMERCIAL] standard_charge|[payer_ASSURED BENEFITS ADMIN]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_ASSURED BENEFITS ADMIN]|[Plan_ COMMERCIAL] standard_charge|[payer_AUXIANT INSURANCE]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_AUXIANT INSURANCE]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_AUXIANT INSURANCE]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AUXIANT INSURANCE]|[plan_ COMMERCIAL] standard_charge|[payer_AUXIANT INSURANCE]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_AUXIANT INSURANCE]|[Plan_ COMMERCIAL] standard_charge|[payer_BAS BENEFIT ADM SYSTEMS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BAS BENEFIT ADM SYSTEMS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BAS BENEFIT ADM SYSTEMS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BAS BENEFIT ADM SYSTEMS]|[plan_ COMMERCIAL] standard_charge|[payer_BAS BENEFIT ADM SYSTEMS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BAS BENEFIT ADM SYSTEMS]|[Plan_ COMMERCIAL] standard_charge|[payer_BCBS CENTENNIAL]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BCBS CENTENNIAL]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BCBS CENTENNIAL]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BCBS CENTENNIAL]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BCBS CENTENNIAL]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BCBS CENTENNIAL]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS FEDERAL]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS OF TX]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF TX]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OF TX]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OF TX]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS OF TX]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OF TX]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE]|[Plan_ BLUE CROSS] standard_charge|[payer_BEACON HEALTH]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEACON HEALTH]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEACON HEALTH]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH]|[plan_ COMMERCIAL] standard_charge|[payer_BEACON HEALTH]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BEACON HEALTH]|[Plan_ COMMERCIAL] standard_charge|[payer_BEAZLEY INS COMPANY INC]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEAZLEY INS COMPANY INC]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEAZLEY INS COMPANY INC]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEAZLEY INS COMPANY INC]|[plan_ COMMERCIAL] standard_charge|[payer_BEAZLEY INS COMPANY INC]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BEAZLEY INS COMPANY INC]|[Plan_ COMMERCIAL] standard_charge|[payer_BOON CHAMPMAN]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BOON CHAMPMAN]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BOON CHAMPMAN]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BOON CHAMPMAN]|[plan_ COMMERCIAL] standard_charge|[payer_BOON CHAMPMAN]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BOON CHAMPMAN]|[Plan_ COMMERCIAL] standard_charge|[payer_CARE MORE HEALTH]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARE MORE HEALTH]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CARE MORE HEALTH]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARE MORE HEALTH]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CARE MORE HEALTH]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CARE MORE HEALTH]|[Plan_ MANAGED MEDICARE] 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 HEALTHCARE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHCARE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHCARE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHCARE]|[plan_ HMO/PPO] standard_charge|[payer_CIGNA HEALTHCARE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA HEALTHCARE]|[Plan_ HMO/PPO] standard_charge|[payer_CIGNA TRUE CHOICE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA TRUE CHOICE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA TRUE CHOICE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA TRUE CHOICE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CIGNA TRUE CHOICE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA TRUE CHOICE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_CLAIMS ADMIN SERVICES]|[plan_ WORKERS COMP]|negotiated_dollar standard_charge|[payer_CLAIMS ADMIN SERVICES]|[plan_ WORKERS COMP] |negotiated_percentage standard_charge|[payer_CLAIMS ADMIN SERVICES]|[plan_ WORKERS COMP] |negotiated_algorithm estimated_amount|[payer_CLAIMS ADMIN SERVICES]|[plan_ WORKERS COMP] standard_charge|[payer_CLAIMS ADMIN SERVICES]|[plan_ WORKERS COMP] |methodology additional_payer_notes |[payer_CLAIMS ADMIN SERVICES]|[Plan_ WORKERS COMP] standard_charge|[payer_DEPT FAMILY AND PROTECTIV]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_DEPT FAMILY AND PROTECTIV]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_DEPT FAMILY AND PROTECTIV]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_DEPT FAMILY AND PROTECTIV]|[plan_ COMMERCIAL] standard_charge|[payer_DEPT FAMILY AND PROTECTIV]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_DEPT FAMILY AND PROTECTIV]|[Plan_ COMMERCIAL] standard_charge|[payer_EBMS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_EBMS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_EBMS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_EBMS]|[plan_ COMMERCIAL] standard_charge|[payer_EBMS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_EBMS]|[Plan_ COMMERCIAL] standard_charge|[payer_EL PASO CHILDRENS HOSPITA]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_EL PASO CHILDRENS HOSPITA]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_EL PASO CHILDRENS HOSPITA]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_EL PASO CHILDRENS HOSPITA]|[plan_ HMO/PPO] standard_charge|[payer_EL PASO CHILDRENS HOSPITA]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_EL PASO CHILDRENS HOSPITA]|[Plan_ HMO/PPO] standard_charge|[payer_EL PASO HEALTH MGD MCD]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EL PASO HEALTH MGD MCD]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EL PASO HEALTH MGD MCD]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EL PASO HEALTH MGD MCD]|[plan_ MANAGED MEDICAID] standard_charge|[payer_EL PASO HEALTH MGD MCD]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EL PASO HEALTH MGD MCD]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_EL PASO HEALTH STAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EL PASO HEALTH STAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EL PASO HEALTH STAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EL PASO HEALTH STAR]|[plan_ MANAGED MEDICAID] standard_charge|[payer_EL PASO HEALTH STAR]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EL PASO HEALTH STAR]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_EL PASO HEALTH STAR PLUS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EL PASO HEALTH STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EL PASO HEALTH STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EL PASO HEALTH STAR PLUS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_EL PASO HEALTH STAR PLUS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EL PASO HEALTH STAR PLUS]|[Plan_ MANAGED MEDICAID] 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_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_GOLDEN RULE]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_GOLDEN RULE]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_GOLDEN RULE]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GOLDEN RULE]|[plan_ COMMERCIAL] standard_charge|[payer_GOLDEN RULE]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_GOLDEN RULE]|[Plan_ COMMERCIAL] standard_charge|[payer_HEALTHPARTNERS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTHPARTNERS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTHPARTNERS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTHPARTNERS]|[plan_ COMMERCIAL] standard_charge|[payer_HEALTHPARTNERS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTHPARTNERS]|[Plan_ COMMERCIAL] standard_charge|[payer_HEALTHSPRING/CIGNA]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HEALTHSPRING/CIGNA]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HEALTHSPRING/CIGNA]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HEALTHSPRING/CIGNA]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HEALTHSPRING/CIGNA]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HEALTHSPRING/CIGNA]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HMC HEALTHWORKS/PHCS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HMC HEALTHWORKS/PHCS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_HMC HEALTHWORKS/PHCS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HMC HEALTHWORKS/PHCS]|[plan_ COMMERCIAL] standard_charge|[payer_HMC HEALTHWORKS/PHCS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_HMC HEALTHWORKS/PHCS]|[Plan_ COMMERCIAL] standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA PPO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA PPO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA PPO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA PPO]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA PPO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA PPO]|[Plan_ HMO/PPO] standard_charge|[payer_HWMG]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HWMG]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_HWMG]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HWMG]|[plan_ COMMERCIAL] standard_charge|[payer_HWMG]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_HWMG]|[Plan_ COMMERCIAL] standard_charge|[payer_ICE HEALTH SVS CORPS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_ICE HEALTH SVS CORPS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_ICE HEALTH SVS CORPS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ICE HEALTH SVS CORPS]|[plan_ COMMERCIAL] standard_charge|[payer_ICE HEALTH SVS CORPS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_ICE HEALTH SVS CORPS]|[Plan_ COMMERCIAL] standard_charge|[payer_INDEPENDENT MEDICAL SYSTE]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_INDEPENDENT MEDICAL SYSTE]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_INDEPENDENT MEDICAL SYSTE]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_INDEPENDENT MEDICAL SYSTE]|[plan_ COMMERCIAL] standard_charge|[payer_INDEPENDENT MEDICAL SYSTE]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_INDEPENDENT MEDICAL SYSTE]|[Plan_ COMMERCIAL] standard_charge|[payer_KAISER PERMANENTE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_KAISER PERMANENTE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_KAISER PERMANENTE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_KAISER PERMANENTE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_KAISER PERMANENTE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MAGELLAN HEALTHCARE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN HEALTHCARE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN HEALTHCARE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN HEALTHCARE]|[plan_ HMO/PPO] standard_charge|[payer_MAGELLAN HEALTHCARE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN HEALTHCARE]|[Plan_ HMO/PPO] standard_charge|[payer_MAGELLAN TX MCD]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MAGELLAN TX MCD]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MAGELLAN TX MCD]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MAGELLAN TX MCD]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MAGELLAN TX MCD]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MAGELLAN TX MCD]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MAGELLAN TX MCR]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MAGELLAN TX MCR]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MAGELLAN TX MCR]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MAGELLAN TX MCR]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MAGELLAN TX MCR]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MAGELLAN TX MCR]|[Plan_ MANAGED MEDICARE] 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_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_MERITAIN HEALTH]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH]|[plan_ COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_MERITAIN HEALTH]|[Plan_ COMMERCIAL] standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MOLINA MARKETPLACE]|[Plan_ HMO/PPO] standard_charge|[payer_MOLINA MEDICAID]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA MEDICAID]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA MEDICAID]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA MEDICAID]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA MEDICAID]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA MEDICAID]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MOLINA MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MOLINA STAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA STAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA STAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA STAR]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA STAR]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA STAR]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA STAR PLUS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA STAR PLUS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA STAR PLUS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA STAR PLUS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID] standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_NEW MEXICO MEDICAID]|[Plan_ MEDICAID] standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_NEW MEXICO MEDICAID]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_NEW MEXICO MEDICAID]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_OMAHA INS COMPANY]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_OMAHA INS COMPANY]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_OMAHA INS COMPANY]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_OMAHA INS COMPANY]|[plan_ COMMERCIAL] standard_charge|[payer_OMAHA INS COMPANY]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_OMAHA INS COMPANY]|[Plan_ COMMERCIAL] standard_charge|[payer_PAN AMERICAN LIFE INS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_PAN AMERICAN LIFE INS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_PAN AMERICAN LIFE INS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PAN AMERICAN LIFE INS]|[plan_ COMMERCIAL] standard_charge|[payer_PAN AMERICAN LIFE INS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_PAN AMERICAN LIFE INS]|[Plan_ COMMERCIAL] standard_charge|[payer_PHP PHYSICIAN HEALTH PLAN]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_PHP PHYSICIAN HEALTH PLAN]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_PHP PHYSICIAN HEALTH PLAN]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PHP PHYSICIAN HEALTH PLAN]|[plan_ COMMERCIAL] standard_charge|[payer_PHP PHYSICIAN HEALTH PLAN]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_PHP PHYSICIAN HEALTH PLAN]|[Plan_ COMMERCIAL] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_POINT COMFORT UNDERWRITER]|[plan_ HMO/PPO] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_POINT COMFORT UNDERWRITER]|[Plan_ HMO/PPO] standard_charge|[payer_PREFERRED ADMINISTRATORS]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_PREFERRED ADMINISTRATORS]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_PREFERRED ADMINISTRATORS]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PREFERRED ADMINISTRATORS]|[plan_ HMO/PPO] standard_charge|[payer_PREFERRED ADMINISTRATORS]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_PREFERRED ADMINISTRATORS]|[Plan_ HMO/PPO] standard_charge|[payer_PRESBYTERIAN MEDICAID]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PRESBYTERIAN MEDICAID]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_PRESBYTERIAN MEDICAID]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_PRESBYTERIAN MEDICAID]|[plan_ MANAGED MEDICAID] standard_charge|[payer_PRESBYTERIAN MEDICAID]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_PRESBYTERIAN MEDICAID]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_PRESBYTERIAN MGD MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_PRESBYTERIAN MGD MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_PRESBYTERIAN MGD MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_PRESBYTERIAN MGD MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_PRESBYTERIAN MGD MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_PRESBYTERIAN MGD MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_PRESBYTERIAN/COMMERCIAL]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_PRESBYTERIAN/COMMERCIAL]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_PRESBYTERIAN/COMMERCIAL]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PRESBYTERIAN/COMMERCIAL]|[plan_ HMO/PPO] standard_charge|[payer_PRESBYTERIAN/COMMERCIAL]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_PRESBYTERIAN/COMMERCIAL]|[Plan_ HMO/PPO] standard_charge|[payer_SANA BENEFITS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_SANA BENEFITS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_SANA BENEFITS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SANA BENEFITS]|[plan_ COMMERCIAL] standard_charge|[payer_SANA BENEFITS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_SANA BENEFITS]|[Plan_ COMMERCIAL] standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SCOTT AND WHITE HEALTH]|[plan_ MANAGED MEDICARE] standard_charge|[payer_SCOTT AND WHITE HEALTH]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SCOTT AND WHITE HEALTH]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_SELECT HEALTH]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_SELECT HEALTH]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_SELECT HEALTH]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SELECT HEALTH]|[plan_ COMMERCIAL] standard_charge|[payer_SELECT HEALTH]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_SELECT HEALTH]|[Plan_ COMMERCIAL] standard_charge|[payer_SIERRA HEALTH LIFE INS]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SIERRA HEALTH LIFE INS]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SIERRA HEALTH LIFE INS]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SIERRA HEALTH LIFE INS]|[plan_ MANAGED MEDICARE] standard_charge|[payer_SIERRA HEALTH LIFE INS]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SIERRA HEALTH LIFE INS]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_SUPERIOR HEALTHCARE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR HEALTHCARE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR HEALTHCARE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR HEALTHCARE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR HEALTHCARE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR HEALTHCARE]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR MCR DUAL]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SUPERIOR MCR DUAL]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SUPERIOR MCR DUAL]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SUPERIOR MCR DUAL]|[plan_ MANAGED MEDICARE] standard_charge|[payer_SUPERIOR MCR DUAL]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SUPERIOR MCR DUAL]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_SUPERIOR STAR]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR STAR]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR STAR]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR STAR]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR STAR]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR STAR]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR STAR PLUS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUPERIOR STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUPERIOR STAR PLUS]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUPERIOR STAR PLUS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR STAR PLUS]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUPERIOR STAR PLUS]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SUPERIOR/AMBETTER]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_SUPERIOR/AMBETTER]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_SUPERIOR/AMBETTER]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SUPERIOR/AMBETTER]|[plan_ HMO/PPO] standard_charge|[payer_SUPERIOR/AMBETTER]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_SUPERIOR/AMBETTER]|[Plan_ HMO/PPO] standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_TEXAS MEDICAID]|[plan_ MEDICAID] standard_charge|[payer_TEXAS MEDICAID]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_TEXAS MEDICAID]|[Plan_ MEDICAID] standard_charge|[payer_THE HEALTH PLAN]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_THE HEALTH PLAN]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_THE HEALTH PLAN]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_THE HEALTH PLAN]|[plan_ COMMERCIAL] standard_charge|[payer_THE HEALTH PLAN]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_THE HEALTH PLAN]|[Plan_ COMMERCIAL] standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST]|[plan_ TRICARE] standard_charge|[payer_TRICARE EAST]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST]|[Plan_ TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE FOR LIFE]|[Plan_ TRICARE] standard_charge|[payer_TRICARE 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_TRUEHEALTH]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_TRUEHEALTH]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_TRUEHEALTH]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_TRUEHEALTH]|[plan_ COMMERCIAL] standard_charge|[payer_TRUEHEALTH]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_TRUEHEALTH]|[Plan_ COMMERCIAL] standard_charge|[payer_UHC COMMUNITY PLAN-TX]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY PLAN-TX]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC COMMUNITY PLAN-TX]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY PLAN-TX]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN-TX]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC COMMUNITY PLAN-TX]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UHC DUAL COMPLETE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC DUAL COMPLETE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC DUAL COMPLETE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC DUAL COMPLETE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UHC DUAL COMPLETE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC DUAL COMPLETE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UHC MEDICAID]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC MEDICAID]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC MEDICAID]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC MEDICAID]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UHC MEDICAID]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC MEDICAID]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_UHC/OPTUM HEALTH]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC/OPTUM HEALTH]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC/OPTUM HEALTH]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC/OPTUM HEALTH]|[plan_ HMO/PPO] standard_charge|[payer_UHC/OPTUM HEALTH]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UHC/OPTUM HEALTH]|[Plan_ HMO/PPO] standard_charge|[payer_UMR]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UMR]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UMR]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_ COMMERCIAL] standard_charge|[payer_UMR]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UMR]|[Plan_ COMMERCIAL] standard_charge|[payer_UNITED HEALTH SHARE SVCS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UNITED HEALTH SHARE SVCS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UNITED HEALTH SHARE SVCS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH SHARE SVCS]|[plan_ COMMERCIAL] standard_charge|[payer_UNITED HEALTH SHARE SVCS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UNITED HEALTH SHARE SVCS]|[Plan_ COMMERCIAL] standard_charge|[payer_US MARSHALLS PECOS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_US MARSHALLS PECOS]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_US MARSHALLS PECOS]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_US MARSHALLS PECOS]|[plan_ COMMERCIAL] standard_charge|[payer_US MARSHALLS PECOS]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_US MARSHALLS PECOS]|[Plan_ COMMERCIAL] standard_charge|[payer_VA WPS CCN]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA WPS CCN]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA WPS CCN]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA WPS CCN]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA WPS CCN]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA WPS CCN]|[Plan_ VETERANS ADMIN] standard_charge|[payer_WEB TPA]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_WEB TPA]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_WEB TPA]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_WEB TPA]|[plan_ COMMERCIAL] standard_charge|[payer_WEB TPA]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_WEB TPA]|[Plan_ COMMERCIAL] 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_WESTERN SKY MGD MCD]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_WESTERN SKY MGD MCD]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_WESTERN SKY MGD MCD]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_WESTERN SKY MGD MCD]|[plan_ MANAGED MEDICAID] standard_charge|[payer_WESTERN SKY MGD MCD]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_WESTERN SKY MGD MCD]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_YSLETA DEL SUR PUEBLO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_YSLETA DEL SUR PUEBLO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_YSLETA DEL SUR PUEBLO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_YSLETA DEL SUR PUEBLO]|[plan_ HMO/PPO] standard_charge|[payer_YSLETA DEL SUR PUEBLO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_YSLETA DEL SUR PUEBLO]|[Plan_ HMO/PPO] additional_generic_notes ROOM AND BOARD ADOL UNIT 124 RC facility Inpatient 2303 750 529 1300 750 per diem 750 per diem 847 per diem 847 per diem 750 per diem 750 per diem 750 per diem 700 per diem 640 per diem 723 per diem 723 per diem 750 per diem 750 per diem 750 per diem 750 per diem 750 per diem 752 per diem 805 per diem 805 per diem 805 per diem 750 per diem 750 per diem 750 per diem 875 per diem 750 per diem 750 per diem 750 per diem 750 per diem 529 per diem 610 per diem 689 per diem 689 per diem 1300 per diem 750 per diem 750 per diem 750 per diem 750 per diem 900 per diem 750 per diem 750 per diem 750 per diem 750 per diem 788 per diem 758 per diem 750 per diem 750 per diem 683 per diem 771 per diem 771 per diem 750 per diem 750 per diem 750 per diem 750 per diem 600 per diem 756 per diem 756 per diem 756 per diem 750 per diem 750 per diem 750 per diem 750 per diem 642 per diem 725 per diem 725 per diem 700 per diem 529 per diem 750 per diem 750 per diem 750 per diem 857 per diem 1160 per diem 750 per diem 529 per diem 932 per diem 750 per diem 750 per diem 750 per diem 750 per diem 700 per diem 750 per diem ELECTOCONVULSIVE THERAPY - OUTPATIENT 901 RC facility Outpatient 1890 398 624 624 per diem 624 per diem 398 per diem ELECTOCONVULSIVE THERAPY-INPATIENT 901 RC facility Inpatient 1890 398 624 624 per diem 624 per diem 398 per diem INTENSIVE OUTPATIENT PROGRAM ADULT CD 905 RC facility Outpatient 859 155 120 400 155 per diem 155 per diem 212 per diem 155 per diem 155 per diem 155 per diem 155 per diem 155 per diem 170 per diem 170 per diem 170 per diem 155 per diem 155 per diem 155 per diem 240 per diem 240 per diem 240 per diem 155 per diem 155 per diem 155 per diem 155 per diem 155 per diem 218 per diem 155 per diem 155 per diem 155 per diem 155 per diem 120 per diem 120 per diem 120 per diem 400 per diem 155 per diem 155 per diem 155 per diem 218 per diem 155 per diem 205 per diem 254 per diem 155 per diem 155 per diem 155 per diem 155 per diem 187 per diem 180 per diem 155 per diem 205 per diem 155 per diem 225 per diem 184 per diem 225 per diem 184 per diem 184 per diem 155 per diem 155 per diem 155 per diem 155 per diem 155 per diem 125 per diem 155 per diem 155 per diem 155 per diem 155 per diem 161 per diem 155 per diem 161 per diem 161 per diem 165 per diem 155 per diem 155 per diem 155 per diem 155 per diem 203 per diem 155 per diem 150 per diem 150 per diem 180 per diem 175 per diem 155 per diem 155 per diem 204 per diem 155 per diem 155 per diem 199 per diem 175 per diem TELE INTENSIVE OUTPATIENT PROGRAM ADOL 905 RC facility Outpatient 859 155 120 400 155 per diem 155 per diem 212 per diem 155 per diem 155 per diem 155 per diem 155 per diem 155 per diem 170 per diem 170 per diem 170 per diem 155 per diem 155 per diem 155 per diem 240 per diem 240 per diem 240 per diem 155 per diem 155 per diem 155 per diem 155 per diem 155 per diem 218 per diem 155 per diem 155 per diem 155 per diem 155 per diem 120 per diem 120 per diem 120 per diem 400 per diem 155 per diem 155 per diem 155 per diem 218 per diem 155 per diem 205 per diem 254 per diem 155 per diem 155 per diem 155 per diem 155 per diem 187 per diem 180 per diem 155 per diem 205 per diem 155 per diem 225 per diem 184 per diem 225 per diem 184 per diem 184 per diem 155 per diem 155 per diem 155 per diem 155 per diem 155 per diem 125 per diem 155 per diem 155 per diem 155 per diem 155 per diem 161 per diem 155 per diem 161 per diem 161 per diem 165 per diem 155 per diem 155 per diem 155 per diem 155 per diem 203 per diem 155 per diem 150 per diem 150 per diem 180 per diem 175 per diem 155 per diem 155 per diem 204 per diem 155 per diem 155 per diem 199 per diem 175 per diem INTENSIVE OUTPATIENT PROGRAM ADULT CD 906 RC facility Outpatient 859 155 155 281 212 per diem 170 per diem 170 per diem 155 per diem 281 per diem 281 per diem 281 per diem 205 per diem 254 per diem 155 per diem 180 per diem 225 per diem 184 per diem 184 per diem 184 per diem 161 per diem 161 per diem 161 per diem 203 per diem 204 per diem 175 per diem PARTIAL HOSPITAL PROGRAM CD ADULT 912 RC facility Outpatient 1149 270 235 647 270 per diem 270 per diem 424 per diem 270 per diem 270 per diem 270 per diem 270 per diem 270 per diem 275 per diem 275 per diem 275 per diem 270 per diem 270 per diem 270 per diem 647 per diem 450 per diem 450 per diem 450 per diem 270 per diem 270 per diem 270 per diem 270 per diem 270 per diem 338 per diem 270 per diem 270 per diem 270 per diem 270 per diem 250 per diem 250 per diem 250 per diem 550 per diem 270 per diem 270 per diem 270 per diem 338 per diem 270 per diem 241 per diem 460 per diem 270 per diem 270 per diem 270 per diem 270 per diem 364 per diem 350 per diem 270 per diem 241 per diem 270 per diem 450 per diem 368 per diem 450 per diem 368 per diem 368 per diem 270 per diem 270 per diem 270 per diem 270 per diem 270 per diem 300 per diem 647 per diem 540 per diem 540 per diem 270 per diem 270 per diem 270 per diem 270 per diem 321 per diem 270 per diem 321 per diem 321 per diem 275 per diem 270 per diem 270 per diem 270 per diem 270 per diem 235 per diem 239 per diem 270 per diem 250 per diem 250 per diem 308 per diem 299 per diem 270 per diem 270 per diem 241 per diem 270 per diem 270 per diem 647 per diem 350 per diem TELE PARTIAL HOSPITAL PROGRAM ADOL 912 RC facility Outpatient 1149 270 235 647 270 per diem 270 per diem 424 per diem 270 per diem 270 per diem 270 per diem 270 per diem 270 per diem 275 per diem 275 per diem 275 per diem 270 per diem 270 per diem 270 per diem 647 per diem 450 per diem 450 per diem 450 per diem 270 per diem 270 per diem 270 per diem 270 per diem 270 per diem 338 per diem 270 per diem 270 per diem 270 per diem 270 per diem 250 per diem 250 per diem 250 per diem 550 per diem 270 per diem 270 per diem 270 per diem 338 per diem 270 per diem 241 per diem 460 per diem 270 per diem 270 per diem 270 per diem 270 per diem 364 per diem 350 per diem 270 per diem 241 per diem 270 per diem 450 per diem 368 per diem 450 per diem 368 per diem 368 per diem 270 per diem 270 per diem 270 per diem 270 per diem 270 per diem 300 per diem 647 per diem 540 per diem 540 per diem 270 per diem 270 per diem 270 per diem 270 per diem 321 per diem 270 per diem 321 per diem 321 per diem 275 per diem 270 per diem 270 per diem 270 per diem 270 per diem 235 per diem 239 per diem 270 per diem 250 per diem 250 per diem 308 per diem 299 per diem 270 per diem 270 per diem 241 per diem 270 per diem 270 per diem 647 per diem 350 per diem INTENSIVE OUTPATIENT PROGRAM CD PROCGROUP 1 ADU 915 RC facility Outpatient 278 75 70 241 70 per diem 241 per diem 241 per diem 235 per diem 239 per diem 241 per diem PARTIAL HOSPITAL PROGRAM CD PROC GROUP1 ADU 915 RC facility Outpatient 223 55 70 241 70 per diem 241 per diem 241 per diem 235 per diem 239 per diem 241 per diem PROCESS GROUP 1 ADULT 915 RC facility Outpatient 223 55 70 241 70 per diem 241 per diem 241 per diem 235 per diem 239 per diem 241 per diem