hospital_name last_updated_on version hospital_location hospital_address license_number|MI "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "Crossroads Regional Hosptial, LLC" 5/31/2024 2.0.0 "Alexandria, Louisiana" 44 Versailles Boulevard license_2203781934 | LA 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]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AETNA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AETNA]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AETNA]|[plan_COMMERCIAL] standard_charge|[payer_AETNA]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AETNA]|[Plan_COMMERCIAL] standard_charge|[payer_AETNA BETTER HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AETNA BETTER HEALTH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AETNA COVENTRY]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA COVENTRY]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA COVENTRY]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA COVENTRY]|[plan_HMO/PPO] standard_charge|[payer_AETNA COVENTRY]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AETNA COVENTRY]|[Plan_HMO/PPO] standard_charge|[payer_AETNA MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MCR SUPPLEMENT CLAI]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AETNA MCR SUPPLEMENT CLAI]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AETNA MCR SUPPLEMENT CLAI]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AETNA MCR SUPPLEMENT CLAI]|[plan_COMMERCIAL] standard_charge|[payer_AETNA MCR SUPPLEMENT CLAI]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AETNA MCR SUPPLEMENT CLAI]|[Plan_COMMERCIAL] standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] standard_charge|[payer_ALL SAVERS UHC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALL SAVERS UHC]|[Plan_HMO/PPO] standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIHEALTH CARITAS]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMERIHEALTH CARITAS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIHEALTH CARITAS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_ARKIDS 1ST]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_ARKIDS 1ST]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_ARKIDS 1ST]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_ARKIDS 1ST]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_ARKIDS 1ST]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_ARKIDS 1ST]|[Plan_MEDICAID: OUT OF STATE] 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 LOUISIANA]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF LOUISIANA]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OF LOUISIANA]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OF LOUISIANA]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OF LOUISIANA]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OF LOUISIANA]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE PLAN]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE PLAN]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE PLAN]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE PLAN]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE PLAN]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE PLAN]|[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_BENEFIT ADMINISTRATVE SVC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BENEFIT ADMINISTRATVE SVC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BENEFIT ADMINISTRATVE SVC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BENEFIT ADMINISTRATVE SVC]|[plan_HMO/PPO] standard_charge|[payer_BENEFIT ADMINISTRATVE SVC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BENEFIT ADMINISTRATVE SVC]|[Plan_HMO/PPO] standard_charge|[payer_CENPATICO BEHAVIORAL HEAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_CENPATICO BEHAVIORAL HEAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CENPATICO BEHAVIORAL HEAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CENPATICO BEHAVIORAL HEAL]|[plan_COMMERCIAL] standard_charge|[payer_CENPATICO BEHAVIORAL HEAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_CENPATICO BEHAVIORAL HEAL]|[Plan_COMMERCIAL] 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]|[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 BEHAVIORAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA BEHAVIORAL]|[Plan_HMO/PPO] standard_charge|[payer_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_DCFS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DCFS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DCFS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DCFS]|[plan_LOCAL GOVT] standard_charge|[payer_DCFS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DCFS]|[Plan_LOCAL GOVT] standard_charge|[payer_DEVOTED HEALTH PLAN TEXAS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_DEVOTED HEALTH PLAN TEXAS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_DEVOTED HEALTH PLAN TEXAS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_DEVOTED HEALTH PLAN TEXAS]|[plan_MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH PLAN TEXAS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_DEVOTED HEALTH PLAN TEXAS]|[Plan_MANAGED MEDICARE] standard_charge|[payer_FIRST CHOICE]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_FIRST CHOICE]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_FIRST CHOICE]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_FIRST CHOICE]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_FIRST CHOICE]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_FIRST CHOICE]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_FLORIDA MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_FLORIDA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_FLORIDA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_FLORIDA MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_FLORIDA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_FLORIDA MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_FOX EVERETT]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_FOX EVERETT]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_FOX EVERETT]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FOX EVERETT]|[plan_HMO/PPO] standard_charge|[payer_FOX EVERETT]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_FOX EVERETT]|[Plan_HMO/PPO] standard_charge|[payer_GEHA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GEHA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GEHA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GEHA]|[plan_HMO/PPO] standard_charge|[payer_GEHA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_GEHA]|[Plan_HMO/PPO] standard_charge|[payer_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_GROUP & PENSION ADMINSTR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GROUP & PENSION ADMINSTR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GROUP & PENSION ADMINSTR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GROUP & PENSION ADMINSTR]|[plan_HMO/PPO] standard_charge|[payer_GROUP & PENSION ADMINSTR]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_GROUP & PENSION ADMINSTR]|[Plan_HMO/PPO] standard_charge|[payer_GROUP PLAN ADMINISTRATORS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GROUP PLAN ADMINISTRATORS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GROUP PLAN ADMINISTRATORS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GROUP PLAN ADMINISTRATORS]|[plan_COMMERCIAL] standard_charge|[payer_GROUP PLAN ADMINISTRATORS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_GROUP PLAN ADMINISTRATORS]|[Plan_COMMERCIAL] standard_charge|[payer_GWL/UHCG ASSISTANCE CLAIM]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GWL/UHCG ASSISTANCE CLAIM]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GWL/UHCG ASSISTANCE CLAIM]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GWL/UHCG ASSISTANCE CLAIM]|[plan_COMMERCIAL] standard_charge|[payer_GWL/UHCG ASSISTANCE CLAIM]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_GWL/UHCG ASSISTANCE CLAIM]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTH PLUS OF LOUISIANA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTH PLUS OF LOUISIANA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTH PLUS OF LOUISIANA]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTH PLUS OF LOUISIANA]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH PLUS OF LOUISIANA]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTH PLUS OF LOUISIANA]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTHNET FEDERAL SRV LLC]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_HEALTHNET FEDERAL SRV LLC]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_HEALTHNET FEDERAL SRV LLC]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_HEALTHNET FEDERAL SRV LLC]|[plan_TRICARE] standard_charge|[payer_HEALTHNET FEDERAL SRV LLC]|[plan_TRICARE] |methodology additional_payer_notes |[payer_HEALTHNET FEDERAL SRV LLC]|[Plan_TRICARE] standard_charge|[payer_HEALTHY BLUE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HEALTHY BLUE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HEALTHY BLUE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HEALTHY BLUE]|[plan_MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HEALTHY BLUE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HEALTHY BLUE DUAL ADVANTA]|[plan_MANAGED MEDICARE] standard_charge|[payer_HEALTHY BLUE DUAL ADVANTA]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HEALTHY BLUE DUAL ADVANTA]|[Plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA COMMERCIAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HUMANA COMMERCIAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HUMANA COMMERCIAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HUMANA COMMERCIAL]|[plan_COMMERCIAL] standard_charge|[payer_HUMANA COMMERCIAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HUMANA COMMERCIAL]|[Plan_COMMERCIAL] standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD CHOICE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA GOLD CHOICE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA HEALTHY HORIZON]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HUMANA HEALTHY HORIZON]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HUMANA HEALTHY HORIZON]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HUMANA HEALTHY HORIZON]|[plan_MANAGED MEDICAID] standard_charge|[payer_HUMANA HEALTHY HORIZON]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_HUMANA HEALTHY HORIZON]|[Plan_MANAGED MEDICAID] standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_INTERFACE EAP]|[plan_HMO/PPO] standard_charge|[payer_INTERFACE EAP]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_INTERFACE EAP]|[Plan_HMO/PPO] standard_charge|[payer_LOUISIANA ARMY NAT GUARD]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_LOUISIANA ARMY NAT GUARD]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_LOUISIANA ARMY NAT GUARD]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_LOUISIANA ARMY NAT GUARD]|[plan_LOCAL GOVT] standard_charge|[payer_LOUISIANA ARMY NAT GUARD]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_LOUISIANA ARMY NAT GUARD]|[Plan_LOCAL GOVT] standard_charge|[payer_LOUISIANA HEALTHCARE CONN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_LOUISIANA HEALTHCARE CONN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_LOUISIANA HEALTHCARE CONN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_LOUISIANA HEALTHCARE CONN]|[plan_MANAGED MEDICAID] standard_charge|[payer_LOUISIANA HEALTHCARE CONN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_LOUISIANA HEALTHCARE CONN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_MANAGED MEDICAID] standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MAGELLAN BEHAVIORAL HEALT]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MAGELLAN DEVOTED HLTH MM]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MAGELLAN DEVOTED HLTH MM]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MAGELLAN DEVOTED HLTH MM]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MAGELLAN DEVOTED HLTH MM]|[plan_COMMERCIAL] standard_charge|[payer_MAGELLAN DEVOTED HLTH MM]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MAGELLAN DEVOTED HLTH MM]|[Plan_COMMERCIAL] standard_charge|[payer_MAGELLAN HMO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN HMO]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN HMO]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN HMO]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN HMO]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN HMO]|[Plan_HMO/PPO] standard_charge|[payer_MAILHANDLERS BENEFIT PLAN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAILHANDLERS BENEFIT PLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAILHANDLERS BENEFIT PLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAILHANDLERS BENEFIT PLAN]|[plan_HMO/PPO] standard_charge|[payer_MAILHANDLERS BENEFIT PLAN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAILHANDLERS BENEFIT PLAN]|[Plan_HMO/PPO] standard_charge|[payer_MCAID PENDING LOUISIANA]|[plan_PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_MCAID PENDING LOUISIANA]|[plan_PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_MCAID PENDING LOUISIANA]|[plan_PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_MCAID PENDING LOUISIANA]|[plan_PENDING MEDICAID] standard_charge|[payer_MCAID PENDING LOUISIANA]|[plan_PENDING MEDICAID] |methodology additional_payer_notes |[payer_MCAID PENDING LOUISIANA]|[Plan_PENDING MEDICAID] standard_charge|[payer_MCD HEALTH PLAN OF NEVADA]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MCD HEALTH PLAN OF NEVADA]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MCD HEALTH PLAN OF NEVADA]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MCD HEALTH PLAN OF NEVADA]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MCD HEALTH PLAN OF NEVADA]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MCD HEALTH PLAN OF NEVADA]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID MOLINA LA]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID MOLINA LA]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID MOLINA LA]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID MOLINA LA]|[plan_MEDICAID ] standard_charge|[payer_MEDICAID MOLINA LA]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID MOLINA LA]|[Plan_MEDICAID ] standard_charge|[payer_MEDICAID QMB]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID QMB]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID QMB]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID QMB]|[plan_MEDICAID ] standard_charge|[payer_MEDICAID QMB]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID QMB]|[Plan_MEDICAID ] standard_charge|[payer_MEDICAID TAKECHARGE]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID TAKECHARGE]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID TAKECHARGE]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID TAKECHARGE]|[plan_MEDICAID ] standard_charge|[payer_MEDICAID TAKECHARGE]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID TAKECHARGE]|[Plan_MEDICAID ] standard_charge|[payer_MEDICAID TX]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MEDICAID TX]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MEDICAID TX]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MEDICAID TX]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID TX]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MEDICAID TX]|[Plan_MEDICAID: OUT OF STATE] 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_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_MERIDIANHEALTH]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MERIDIANHEALTH]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MERIDIANHEALTH]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MERIDIANHEALTH]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MERIDIANHEALTH]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MERIDIANHEALTH]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_METRO HEALTH PLUS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_METRO HEALTH PLUS]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_METRO HEALTH PLUS]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_METRO HEALTH PLUS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_METRO HEALTH PLUS]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_METRO HEALTH PLUS]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MHNET COVENTRY]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MHNET COVENTRY]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MHNET COVENTRY]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MHNET COVENTRY]|[plan_COMMERCIAL] standard_charge|[payer_MHNET COVENTRY]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MHNET COVENTRY]|[Plan_COMMERCIAL] 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_MISSISSIPPI MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MISSISSIPPI MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MISSISSIPPI MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MISSISSIPPI MCD]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MISSISSIPPI MCD]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MISSISSIPPI MCD]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICARE] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MOLINA HEALTHCARE OF OHIO]|[Plan_MANAGED MEDICARE] standard_charge|[payer_NEW YORK MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_NEW YORK MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_NEW YORK MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_NEW YORK MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_NEW YORK MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_NEW YORK MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM BEHAVIORAL HEALTH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HLTH MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OPTUM BEHAVIORAL HLTH MCD]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_OPTUM BEHAVIORAL HLTH MCD]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_OPTUM BEHAVIORAL HLTH MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM BEHAVIORAL HLTH MCD]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_OPTUM BEHAVIORAL HLTH MCD]|[Plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM MCR PPO/HMO]|[plan_HMO/PPO] standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM MCR PPO/HMO]|[Plan_HMO/PPO] standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_OPTUM MCR PPO/HMO]|[plan_MANAGED MEDICARE] standard_charge|[payer_OPTUM MCR PPO/HMO]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_OPTUM MCR PPO/HMO]|[Plan_MANAGED MEDICARE] standard_charge|[payer_OPTUM SAN DIEGO]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OPTUM SAN DIEGO]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OPTUM SAN DIEGO]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OPTUM SAN DIEGO]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM SAN DIEGO]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OPTUM SAN DIEGO]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_RIVER VALLEY ENTITY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_RIVER VALLEY ENTITY]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_RIVER VALLEY ENTITY]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_RIVER VALLEY ENTITY]|[plan_MANAGED MEDICAID] standard_charge|[payer_RIVER VALLEY ENTITY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_RIVER VALLEY ENTITY]|[Plan_MANAGED MEDICAID] standard_charge|[payer_SHEET METAL WORKERS NHF]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_SHEET METAL WORKERS NHF]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_SHEET METAL WORKERS NHF]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_SHEET METAL WORKERS NHF]|[plan_HMO/PPO] standard_charge|[payer_SHEET METAL WORKERS NHF]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_SHEET METAL WORKERS NHF]|[Plan_HMO/PPO] standard_charge|[payer_STUDENT ASSURANCE SERVICE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_STUDENT ASSURANCE SERVICE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_STUDENT ASSURANCE SERVICE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_STUDENT ASSURANCE SERVICE]|[plan_COMMERCIAL] standard_charge|[payer_STUDENT ASSURANCE SERVICE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_STUDENT ASSURANCE SERVICE]|[Plan_COMMERCIAL] standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_STUDENT RESOURCES]|[Plan_COMMERCIAL] standard_charge|[payer_TEXAS STARPLUS MCD]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_TEXAS STARPLUS MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_TEXAS STARPLUS MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_TEXAS STARPLUS MCD]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_TEXAS STARPLUS MCD]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_TEXAS STARPLUS MCD]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_TRICARE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE]|[plan_TRICARE] standard_charge|[payer_TRICARE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE]|[Plan_TRICARE] standard_charge|[payer_TRICARE ACTIVE DUTY]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE ACTIVE DUTY]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE ACTIVE DUTY]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE ACTIVE DUTY]|[plan_TRICARE] standard_charge|[payer_TRICARE ACTIVE DUTY]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE ACTIVE DUTY]|[Plan_TRICARE] standard_charge|[payer_TRICARE ACTIVE DUTY2]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE ACTIVE DUTY2]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE ACTIVE DUTY2]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE ACTIVE DUTY2]|[plan_TRICARE] standard_charge|[payer_TRICARE ACTIVE DUTY2]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE ACTIVE DUTY2]|[Plan_TRICARE] 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 WEST HNFS]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE WEST HNFS]|[plan_TRICARE] standard_charge|[payer_TRICARE WEST HNFS]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE WEST HNFS]|[Plan_TRICARE] standard_charge|[payer_TUNICA BILOXI]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TUNICA BILOXI]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_TUNICA BILOXI]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_TUNICA BILOXI]|[plan_HMO/PPO] standard_charge|[payer_TUNICA BILOXI]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_TUNICA BILOXI]|[Plan_HMO/PPO] standard_charge|[payer_UBH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UBH]|[plan_HMO/PPO] standard_charge|[payer_UBH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UBH]|[Plan_HMO/PPO] standard_charge|[payer_UBH CLAIMS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UBH CLAIMS]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UBH CLAIMS]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UBH CLAIMS]|[plan_MANAGED MEDICAID] standard_charge|[payer_UBH CLAIMS]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UBH CLAIMS]|[Plan_MANAGED MEDICAID] standard_charge|[payer_UHC DUAL COMPLETE PLAN]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC DUAL COMPLETE PLAN]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC DUAL COMPLETE PLAN]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC DUAL COMPLETE PLAN]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC DUAL COMPLETE PLAN]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC DUAL COMPLETE PLAN]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] standard_charge|[payer_UHC SHARED SERVICES]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHC SHARED SERVICES]|[Plan_HMO/PPO] standard_charge|[payer_UHIS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHIS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHIS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHIS]|[plan_HMO/PPO] standard_charge|[payer_UHIS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHIS]|[Plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UMR]|[Plan_HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH SHARED SERV]|[plan_HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTH SHARED SERV]|[Plan_HMO/PPO] standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTH SHARED SERV]|[plan_MANAGED MEDICAID] standard_charge|[payer_UNITED HEALTH SHARED SERV]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UNITED HEALTH SHARED SERV]|[Plan_MANAGED MEDICAID] standard_charge|[payer_VA CONSOLIDATED FEE UNIT]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA CONSOLIDATED FEE UNIT]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA CONSOLIDATED FEE UNIT]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA CONSOLIDATED FEE UNIT]|[plan_VETERANS ADMIN] standard_charge|[payer_VA CONSOLIDATED FEE UNIT]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA CONSOLIDATED FEE UNIT]|[Plan_VETERANS ADMIN] standard_charge|[payer_VACCN OPTUM-MEDICAL]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VACCN OPTUM-MEDICAL]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VACCN OPTUM-MEDICAL]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VACCN OPTUM-MEDICAL]|[plan_VETERANS ADMIN] standard_charge|[payer_VACCN OPTUM-MEDICAL]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VACCN OPTUM-MEDICAL]|[Plan_VETERANS ADMIN] standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_VANTAGE HEALTH PLAN]|[Plan_COMMERCIAL] standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH PLAN]|[plan_MANAGED MEDICARE] standard_charge|[payer_VANTAGE HEALTH PLAN]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_VANTAGE HEALTH PLAN]|[Plan_MANAGED MEDICARE] standard_charge|[payer_VANTAGE HEALTH PLAN COMM]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_VANTAGE HEALTH PLAN COMM]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_VANTAGE HEALTH PLAN COMM]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_VANTAGE HEALTH PLAN COMM]|[plan_MANAGED MEDICARE] standard_charge|[payer_VANTAGE HEALTH PLAN COMM]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_VANTAGE HEALTH PLAN COMM]|[Plan_MANAGED MEDICARE] standard_charge|[payer_WEB TPA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_WEB TPA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_WEB TPA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_WEB TPA]|[plan_HMO/PPO] standard_charge|[payer_WEB TPA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_WEB TPA]|[Plan_HMO/PPO] standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ZELIS/GILSBAR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ZELIS/GILSBAR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ZELIS/GILSBAR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ZELIS/GILSBAR]|[plan_HMO/PPO] standard_charge|[payer_ZELIS/GILSBAR]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ZELIS/GILSBAR]|[Plan_HMO/PPO] additional_generic_notes ROOM AND BOARD ADOLESCENT-PSYCH 124 RC facility inpatient 2400 750 448 2400 832 per diem 775 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 529 per diem 823 per diem 823 per diem 823 per diem 820 per diem 1120 per diem 448 per diem 853 per diem 853 per diem 800 per diem 738 per diem 529 per diem 529 per diem 529 per diem 750 per diem 700 per diem 800 per diem 750 per diem 650 per diem 2200 per diem 1600 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1421 per diem 832 per diem 738 per diem 529 per diem 738 per diem 738 per diem 738 per diem 529 per diem 784 per diem 529 per diem 529 per diem 784 per diem 2400 per diem 529 per diem 2200 per diem 529 per diem 772 per diem 738 per diem 750 per diem 529 per diem 600 per diem 750 per diem 2200 per diem 2200 per diem 529 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 725 per diem 772 per diem 448 per diem 772 per diem 750 per diem 700 per diem 772 per diem 750 per diem 1063 per diem 1000 per diem 750 per diem 700 per diem ROOM AND BOARD ADULT PSYCH 124 RC facility inpatient 2400 750 448 2400 832 per diem 775 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 529 per diem 823 per diem 823 per diem 823 per diem 820 per diem 1120 per diem 448 per diem 853 per diem 853 per diem 800 per diem 738 per diem 529 per diem 529 per diem 529 per diem 750 per diem 700 per diem 800 per diem 750 per diem 650 per diem 2200 per diem 1600 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1421 per diem 832 per diem 738 per diem 529 per diem 738 per diem 738 per diem 738 per diem 529 per diem 784 per diem 529 per diem 529 per diem 784 per diem 2400 per diem 529 per diem 2200 per diem 529 per diem 772 per diem 738 per diem 750 per diem 529 per diem 600 per diem 750 per diem 2200 per diem 2200 per diem 529 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 725 per diem 772 per diem 448 per diem 772 per diem 750 per diem 700 per diem 772 per diem 750 per diem 1063 per diem 1000 per diem 750 per diem 700 per diem ROOM AND BOARD CHILD-PSYCH 124 RC facility inpatient 2400 750 448 2400 832 per diem 775 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 529 per diem 823 per diem 823 per diem 823 per diem 820 per diem 1120 per diem 448 per diem 853 per diem 853 per diem 800 per diem 738 per diem 529 per diem 529 per diem 529 per diem 750 per diem 700 per diem 800 per diem 750 per diem 650 per diem 2200 per diem 1600 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1421 per diem 832 per diem 738 per diem 529 per diem 738 per diem 738 per diem 738 per diem 529 per diem 784 per diem 529 per diem 529 per diem 784 per diem 2400 per diem 529 per diem 2200 per diem 529 per diem 772 per diem 738 per diem 750 per diem 529 per diem 600 per diem 750 per diem 2200 per diem 2200 per diem 529 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 725 per diem 772 per diem 448 per diem 772 per diem 750 per diem 700 per diem 772 per diem 750 per diem 1063 per diem 1000 per diem 750 per diem 700 per diem ROOM AND BOARD GERIATRIC-PSYCH 124 RC facility inpatient 2400 750 448 2400 832 per diem 775 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 529 per diem 823 per diem 823 per diem 823 per diem 820 per diem 1120 per diem 448 per diem 853 per diem 853 per diem 800 per diem 738 per diem 529 per diem 529 per diem 529 per diem 750 per diem 700 per diem 800 per diem 750 per diem 650 per diem 2200 per diem 1600 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1421 per diem 832 per diem 738 per diem 529 per diem 738 per diem 738 per diem 738 per diem 529 per diem 784 per diem 529 per diem 529 per diem 784 per diem 2400 per diem 529 per diem 2200 per diem 529 per diem 772 per diem 738 per diem 750 per diem 529 per diem 600 per diem 750 per diem 2200 per diem 2200 per diem 529 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 725 per diem 772 per diem 448 per diem 772 per diem 750 per diem 700 per diem 772 per diem 750 per diem 1063 per diem 1000 per diem 750 per diem 700 per diem ROOM AND BOARD ADOLESCENT-DETOX 126 RC facility inpatient 2400 750 529 2400 832 per diem 775 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 529 per diem 756 per diem 756 per diem 756 per diem 820 per diem 1120 per diem 853 per diem 853 per diem 800 per diem 529 per diem 529 per diem 529 per diem 750 per diem 700 per diem 700 per diem 750 per diem 650 per diem 2200 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1421 per diem 832 per diem 738 per diem 529 per diem 738 per diem 738 per diem 738 per diem 529 per diem 784 per diem 529 per diem 529 per diem 784 per diem 2400 per diem 529 per diem 2200 per diem 529 per diem 772 per diem 738 per diem 750 per diem 529 per diem 2200 per diem 2200 per diem 529 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 725 per diem 772 per diem 772 per diem 750 per diem 750 per diem 1063 per diem 1000 per diem 700 per diem ROOM AND BOARD ADULT DETOX 126 RC facility inpatient 2400 750 529 2400 832 per diem 775 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 529 per diem 756 per diem 756 per diem 756 per diem 820 per diem 1120 per diem 853 per diem 853 per diem 800 per diem 529 per diem 529 per diem 529 per diem 750 per diem 700 per diem 700 per diem 750 per diem 650 per diem 2200 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1421 per diem 832 per diem 738 per diem 529 per diem 738 per diem 738 per diem 738 per diem 529 per diem 784 per diem 529 per diem 529 per diem 784 per diem 2400 per diem 529 per diem 2200 per diem 529 per diem 772 per diem 738 per diem 750 per diem 529 per diem 2200 per diem 2200 per diem 529 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 725 per diem 772 per diem 772 per diem 750 per diem 750 per diem 1063 per diem 1000 per diem 700 per diem ROOM AND BOARD ADOLESCENT-CDRHB 128 RC facility inpatient 2400 750 650 2400 832 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 756 per diem 756 per diem 756 per diem 820 per diem 1120 per diem 853 per diem 853 per diem 800 per diem 750 per diem 700 per diem 675 per diem 750 per diem 650 per diem 2200 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1396 per diem 832 per diem 738 per diem 738 per diem 738 per diem 738 per diem 784 per diem 784 per diem 2400 per diem 2200 per diem 772 per diem 738 per diem 750 per diem 2200 per diem 2200 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 772 per diem 772 per diem 1063 per diem 1000 per diem 700 per diem ROOM AND BOARD ADULT-CD REHAB 128 RC facility inpatient 2400 750 650 2400 832 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 756 per diem 756 per diem 756 per diem 820 per diem 1120 per diem 853 per diem 853 per diem 800 per diem 750 per diem 700 per diem 675 per diem 750 per diem 650 per diem 2200 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1396 per diem 832 per diem 738 per diem 738 per diem 738 per diem 738 per diem 784 per diem 784 per diem 2400 per diem 2200 per diem 772 per diem 738 per diem 750 per diem 2200 per diem 2200 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 772 per diem 772 per diem 1063 per diem 1000 per diem 700 per diem ROOM AND BOARD CD/REHAB ADULT 128 RC facility inpatient 2400 750 650 2400 832 per diem 832 per diem 832 per diem 832 per diem 750 per diem 775 per diem 756 per diem 756 per diem 756 per diem 820 per diem 1120 per diem 853 per diem 853 per diem 800 per diem 750 per diem 700 per diem 675 per diem 750 per diem 650 per diem 2200 per diem 1131 per diem 793 per diem 800 per diem 782 per diem 775 per diem 988 per diem 811 per diem 738 per diem 721 per diem 1396 per diem 832 per diem 738 per diem 738 per diem 738 per diem 738 per diem 784 per diem 784 per diem 2400 per diem 2200 per diem 772 per diem 738 per diem 750 per diem 2200 per diem 2200 per diem 1241 per diem 1241 per diem 1192 per diem 1241 per diem 1255 per diem 772 per diem 772 per diem 1063 per diem 1000 per diem 700 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH-ADOLESCENT 905 RC facility outpatient 600 150 143 600 174 per diem 175 per diem 175 per diem 220 per diem 181 per diem 209 per diem 209 per diem 300 per diem 350 per diem 250 per diem 600 per diem 175 per diem 200 per diem 143 per diem 144 per diem 170 per diem 147 per diem 159 per diem 147 per diem 181 per diem 225 per diem 225 per diem 600 per diem 600 per diem 205 per diem 144 per diem 205 per diem 600 per diem 600 per diem 181 per diem 181 per diem 181 per diem 181 per diem 181 per diem 144 per diem 205 per diem 205 per diem 205 per diem 600 per diem 181 per diem 325 per diem 325 per diem 206 per diem 350 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH-ADULT 905 RC facility outpatient 600 150 143 600 174 per diem 175 per diem 175 per diem 220 per diem 181 per diem 209 per diem 209 per diem 300 per diem 350 per diem 250 per diem 600 per diem 175 per diem 200 per diem 143 per diem 144 per diem 170 per diem 147 per diem 159 per diem 147 per diem 181 per diem 225 per diem 225 per diem 600 per diem 600 per diem 205 per diem 144 per diem 205 per diem 600 per diem 600 per diem 181 per diem 181 per diem 181 per diem 181 per diem 181 per diem 144 per diem 205 per diem 205 per diem 205 per diem 600 per diem 181 per diem 325 per diem 325 per diem 206 per diem 350 per diem INTENSIVE OUTPATIENT PROGRAM CD GRP MCD 906 RC facility outpatient 200 150 144 600 174 per diem 144 per diem 144 per diem 209 per diem 209 per diem 250 per diem 600 per diem 144 per diem 144 per diem 144 per diem 600 per diem 144 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM CD-ADOL 906 RC facility outpatient 600 150 144 600 174 per diem 144 per diem 144 per diem 209 per diem 209 per diem 250 per diem 600 per diem 144 per diem 144 per diem 144 per diem 600 per diem 144 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM CD-ADULT 906 RC facility outpatient 600 150 144 600 174 per diem 144 per diem 144 per diem 209 per diem 209 per diem 250 per diem 600 per diem 144 per diem 144 per diem 144 per diem 600 per diem 144 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM CD PROCESS GRP 1 915 RC facility outpatient 200 143 600 144 per diem 209 per diem 209 per diem 300 per diem 600 per diem 144 per diem 143 per diem 144 per diem 144 per diem per diem 600 per diem 144 per diem 600 per diem 600 per diem 181 per diem 181 per diem 181 per diem 205 per diem 205 per diem 600 per diem 181 per diem 425 per diem 425 per diem 206 per diem Psych Eval - Non Medical 90791 RC facility inpatient 250 87 108 87 fee schedule 108 fee schedule 108 fee schedule Psych Eval - With Medical 90792 RC facility inpatient 310 60 1125 88 fee schedule 167 fee schedule 174 fee schedule 108 fee schedule 90 fee schedule 142 fee schedule 66 fee schedule 85 fee schedule 1125 fee schedule 78 fee schedule 142 fee schedule 75 fee schedule 95 fee schedule 60 fee schedule 167 fee schedule Outpatient - Est Approx 25 Min 99214 RC facility outpatient 200 22 95 88 fee schedule 79 fee schedule 25 fee schedule 54 fee schedule 37 fee schedule 45 fee schedule 91 fee schedule 22 fee schedule 95 fee schedule Initial Hospital Care (70 Min) 99223 RC facility inpatient 255 49 154 116 fee schedule 129 fee schedule 114 fee schedule 100 fee schedule 154 fee schedule 111 fee schedule 49 fee schedule 105 fee schedule 106 fee schedule Subseq Care (15 Min) 99231 RC facility inpatient 90 19 48 27 fee schedule 48 fee schedule 24 fee schedule 19 fee schedule Subseq Care (25 Min) 99232 RC facility inpatient 115 43 116 48 fee schedule 76 fee schedule 46 fee schedule 43 fee schedule 48 fee schedule 56 fee schedule 46 fee schedule 56 fee schedule 116 fee schedule 99 fee schedule Subseq Care (35 Min) 99233 RC facility inpatient 175 43 104 56 fee schedule 69 fee schedule 104 fee schedule 71 fee schedule 58 fee schedule 77 fee schedule 97 fee schedule 59 fee schedule 58 fee schedule 77 fee schedule 72 fee schedule 45 fee schedule 85 fee schedule 58 fee schedule 43 fee schedule Discharge Day Mgmt <30 Min 99238 RC facility inpatient 150 42 95 47 fee schedule 77 fee schedule 42 fee schedule 47 fee schedule 95 fee schedule Discharge Day Management >30 Min 99239 RC facility inpatient 200 41 111 111 fee schedule 58 fee schedule 109 fee schedule 54 fee schedule 60 fee schedule 69 fee schedule 93 fee schedule 67 fee schedule 57 fee schedule 86 fee schedule 41 fee schedule 60 fee schedule 111 fee schedule