hospital_name last_updated_on version hospital_location hospital_address license_number|TN "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded in this machine-readable file is true, accurate, and complete as of the date indicated in this file" "Dowell Springs Behavioral Health, LLC" 5/31/2024 2.0.0 "Knoxville, Tennessee" 1444 Old Wisgarber Rd. license_ L000000033642 | TN 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 ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_AARP ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_AARP ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AARP ]|[plan_ COMMERCIAL] standard_charge|[payer_AARP ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_AARP ]|[Plan_ COMMERCIAL] 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 MEDICARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_AMBETTER ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_AMBETTER ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_AMBETTER ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AMBETTER ]|[plan_ COMMERCIAL] standard_charge|[payer_AMBETTER ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_AMBETTER ]|[Plan_ COMMERCIAL] standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_AMERIVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_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 TENNESSEE ]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF TENNESSEE ]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OF TENNESSEE ]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OF TENNESSEE ]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE ]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OF TENNESSEE ]|[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 OPTIONS ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS ]|[plan_ COMMERCIAL] standard_charge|[payer_BEACON HEALTH OPTIONS ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS ]|[Plan_ COMMERCIAL] 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_BEHAVIORAL HEALTH SYSTEMS ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEHAVIORAL HEALTH SYSTEMS ]|[plan_ COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS ]|[Plan_ COMMERCIAL] standard_charge|[payer_BLUE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BLUE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUE ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BLUECARE ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BLUECARE ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BLUECARE ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BLUECARE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_BLUECARE ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BLUECARE ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_BLUECARE PLUS ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUECARE PLUS ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUECARE PLUS ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUECARE PLUS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BLUECARE PLUS ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUECARE PLUS ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_BRIGHT HEALTH ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_BRIGHT HEALTH ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BRIGHT HEALTH ]|[plan_ COMMERCIAL] standard_charge|[payer_BRIGHT HEALTH ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_BRIGHT HEALTH ]|[Plan_ COMMERCIAL] standard_charge|[payer_BRIGHT HLTH MDR ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BRIGHT HLTH MDR ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BRIGHT HLTH MDR ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BRIGHT HLTH MDR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BRIGHT HLTH MDR ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BRIGHT HLTH MDR ]|[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 ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_CIGNA ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_CIGNA ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CIGNA ]|[plan_ COMMERCIAL] standard_charge|[payer_CIGNA ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_CIGNA ]|[Plan_ COMMERCIAL] 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 HEALTHSPRINGS ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHSPRINGS ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHSPRINGS ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHSPRINGS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRINGS ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTHSPRINGS ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_DEVOTED HEALTH]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_DEVOTED HEALTH]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_DEVOTED HEALTH]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_DEVOTED HEALTH]|[plan_ COMMERCIAL] standard_charge|[payer_DEVOTED HEALTH]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_DEVOTED HEALTH]|[Plan_ COMMERCIAL] standard_charge|[payer_GILSBAR ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_GILSBAR ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_GILSBAR ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GILSBAR ]|[plan_ COMMERCIAL] standard_charge|[payer_GILSBAR ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_GILSBAR ]|[Plan_ COMMERCIAL] standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GILSBAR ]|[plan_ HMO/PPO] standard_charge|[payer_GILSBAR ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_GILSBAR ]|[Plan_ HMO/PPO] standard_charge|[payer_HARTFORD ]|[plan_ WORKERS COMP]|negotiated_dollar standard_charge|[payer_HARTFORD ]|[plan_ WORKERS COMP] |negotiated_percentage standard_charge|[payer_HARTFORD ]|[plan_ WORKERS COMP] |negotiated_algorithm estimated_amount|[payer_HARTFORD ]|[plan_ WORKERS COMP] standard_charge|[payer_HARTFORD ]|[plan_ WORKERS COMP] |methodology additional_payer_notes |[payer_HARTFORD ]|[Plan_ WORKERS COMP] standard_charge|[payer_HEALTH PLANS INC.]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTH PLANS INC.]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTH PLANS INC.]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTH PLANS INC.]|[plan_ COMMERCIAL] standard_charge|[payer_HEALTH PLANS INC.]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTH PLANS INC.]|[Plan_ COMMERCIAL] standard_charge|[payer_HEALTHSCOPE BENEFITS ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTHSCOPE BENEFITS ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTHSCOPE BENEFITS ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTHSCOPE BENEFITS ]|[plan_ COMMERCIAL] standard_charge|[payer_HEALTHSCOPE BENEFITS ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTHSCOPE BENEFITS ]|[Plan_ COMMERCIAL] standard_charge|[payer_HUMANA ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HUMANA ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_HUMANA ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HUMANA ]|[plan_ COMMERCIAL] standard_charge|[payer_HUMANA ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_HUMANA ]|[Plan_ COMMERCIAL] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_LUCENT HEALTH ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_LUCENT HEALTH ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_LUCENT HEALTH ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_LUCENT HEALTH ]|[plan_ COMMERCIAL] standard_charge|[payer_LUCENT HEALTH ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_LUCENT HEALTH ]|[Plan_ COMMERCIAL] standard_charge|[payer_MAGELLAN ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MAGELLAN ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_MAGELLAN ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MAGELLAN ]|[plan_ COMMERCIAL] standard_charge|[payer_MAGELLAN ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_MAGELLAN ]|[Plan_ COMMERCIAL] standard_charge|[payer_MEDICAID TN ]|[plan_ MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID TN ]|[plan_ MEDICAID ] |negotiated_percentage standard_charge|[payer_MEDICAID TN ]|[plan_ MEDICAID ] |negotiated_algorithm estimated_amount|[payer_MEDICAID TN ]|[plan_ MEDICAID ] standard_charge|[payer_MEDICAID TN ]|[plan_ MEDICAID ] |methodology additional_payer_notes |[payer_MEDICAID TN ]|[Plan_ MEDICAID ] standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE ]|[plan_ MEDICARE] standard_charge|[payer_MEDICARE ]|[plan_ MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE ]|[Plan_ MEDICARE] standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_MISC COMMERCIAL ]|[Plan_ COMMERCIAL] standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO] standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MISC HMO/PPO ]|[Plan_ HMO/PPO] standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MISC MGD MCARE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MISC MGD MCD ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MISC OOS MEDICAID ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MISC OOS MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MISC OOS MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MISC OOS MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MISC OOS MEDICAID ]|[plan_ MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MISC OOS MEDICAID ]|[Plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_NEW ERA LIFE INS ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_NEW ERA LIFE INS ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_NEW ERA LIFE INS ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_NEW ERA LIFE INS ]|[plan_ COMMERCIAL] standard_charge|[payer_NEW ERA LIFE INS ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_NEW ERA LIFE INS ]|[Plan_ COMMERCIAL] standard_charge|[payer_SUREST UHSS ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_SUREST UHSS ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_SUREST UHSS ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SUREST UHSS ]|[plan_ COMMERCIAL] standard_charge|[payer_SUREST UHSS ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_SUREST UHSS ]|[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_UBH OPTUM ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UBH OPTUM ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UBH OPTUM ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UBH OPTUM ]|[plan_ COMMERCIAL] standard_charge|[payer_UBH OPTUM ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UBH OPTUM ]|[Plan_ COMMERCIAL] standard_charge|[payer_UHC ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UHC ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UHC ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UHC ]|[plan_ COMMERCIAL] standard_charge|[payer_UHC ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UHC ]|[Plan_ COMMERCIAL] standard_charge|[payer_UHC ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC ]|[plan_ HMO/PPO] standard_charge|[payer_UHC ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UHC ]|[Plan_ HMO/PPO] standard_charge|[payer_UHC AARP ADVAN ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC AARP ADVAN ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC AARP ADVAN ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC AARP ADVAN ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UHC AARP ADVAN ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC AARP ADVAN ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC ADVANTAGE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UHC ADVANTAGE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC ADVANTAGE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC COMMUNITY PLAN ]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_UHC SNP DUAL COMPLETE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC SNP DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC SNP DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC SNP DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UHC SNP DUAL COMPLETE ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC SNP DUAL COMPLETE ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UHC STUDENT RESOURCE ]|[plan_ COMMERCIAL] standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UHC STUDENT RESOURCE ]|[Plan_ COMMERCIAL] standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHC STUDENT RESOURCE ]|[plan_ HMO/PPO] standard_charge|[payer_UHC STUDENT RESOURCE ]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UHC STUDENT RESOURCE ]|[Plan_ HMO/PPO] standard_charge|[payer_UMR ]|[plan_ 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 BEHAVIORAL HEALTH ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ COMMERCIAL] standard_charge|[payer_UNITED BEHAVIORAL HEALTH ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH ]|[Plan_ COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UPMC HEALTH PLAN ]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_UPMC HEALTH PLAN ]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UPMC HEALTH PLAN ]|[plan_ COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN ]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_UPMC HEALTH PLAN ]|[Plan_ COMMERCIAL] standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA CCN OPTUM ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA CCN OPTUM ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_VA FEE BASIS PROGRAMS ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA FEE BASIS PROGRAMS ]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA FEE BASIS PROGRAMS ]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA FEE BASIS PROGRAMS ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA FEE BASIS PROGRAMS ]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA FEE BASIS PROGRAMS ]|[Plan_ VETERANS ADMIN] standard_charge|[payer_VIVA HEALTH MEDICARE INC ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_VIVA HEALTH MEDICARE INC ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_VIVA HEALTH MEDICARE INC ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_VIVA HEALTH MEDICARE INC ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_VIVA HEALTH MEDICARE INC ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_VIVA HEALTH MEDICARE INC ]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_WELLCARE HEALTH PLANS ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE HEALTH PLANS ]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE HEALTH PLANS ]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE HEALTH PLANS ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_WELLCARE HEALTH PLANS ]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE HEALTH PLANS ]|[Plan_ MANAGED MEDICARE] additional_generic_notes LOA ADULT UNIT 124 RC facility inpatient 2500 900 675 2500 2500 per diem 2500 per diem 675 per diem 1125 per diem 1125 per diem 1125 per diem 2500 per diem 1000 per diem 1125 per diem 700 per diem 700 per diem 2500 per diem 2500 per diem 1092 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 750 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem ROOM AND BOARD PSYCH AD1 UNIT 124 RC facility inpatient 2500 900 675 2500 2500 per diem 2500 per diem 675 per diem 1125 per diem 1125 per diem 1125 per diem 2500 per diem 1000 per diem 1125 per diem 700 per diem 700 per diem 2500 per diem 2500 per diem 1092 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 750 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem 2500 per diem ELECTOCONVULSIVE THERAPY - INPATIENT 901 RC facility both 2400 1600 750 4800 4800 per diem 2400 per diem 4800 per diem 750 per diem 2400 per diem 1576 per diem 1576 per diem 1576 per diem 2400 per diem 2400 per diem 1400 per diem 1576 per diem 950 per diem 950 per diem 4800 per diem 2400 per diem 4800 per diem 792 per diem 792 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 940 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem ELECTOCONVULSIVE THERAPY - OUTPATIENT 901 RC facility both 2400 1600 750 4800 4800 per diem 2400 per diem 4800 per diem 750 per diem 2400 per diem 1576 per diem 1576 per diem 1576 per diem 2400 per diem 2400 per diem 1400 per diem 1576 per diem 950 per diem 950 per diem 4800 per diem 2400 per diem 4800 per diem 792 per diem 792 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem 2400 per diem 940 per diem 2400 per diem 2400 per diem 2400 per diem 4800 per diem 4800 per diem 4800 per diem 4800 per diem 2400 per diem 2400 per diem 2400 per diem INTENSIVE OUTPATIENT PROGRAM OP PROGRAM-PSYCH 905 RC facility outpatient 600 250 131 600 600 per diem 600 per diem 600 per diem 131 per diem 600 per diem 282 per diem 282 per diem 282 per diem 600 per diem 250 per diem 282 per diem 160 per diem 160 per diem 600 per diem 600 per diem 290 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 150 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM ADOLESCENT 906 RC facility outpatient 600 250 600 600 per diem 600 per diem 600 per diem 600 per diem 250 per diem 282 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem 600 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 910 RC facility outpatient 200 600 600 600 per diem 600 per diem 600 per diem PARTIAL HOSPITAL PROGRAM -ADOLESCENT 912 RC facility outpatient 800 500 242 800 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 550 per diem 800 per diem 425 per diem 550 per diem 242 per diem 800 per diem 800 per diem 800 per diem 422 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem PARTIAL HOSPITAL PROGRAM OP PROGRAM 912 RC facility outpatient 800 500 242 800 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 550 per diem 800 per diem 425 per diem 550 per diem 242 per diem 800 per diem 800 per diem 800 per diem 422 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 260 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem PARTIAL HOSPITAL PROGRAM PROCESS GROUP 915 RC facility outpatient 180 242 800 242 per diem 242 per diem 800 per diem 800 per diem 800 per diem INTIAL HOSPITAL CARE (30 MIN) 99221 RC facility outpatient 240 15 240 105 fee schedule average rate 240 fee schedule average rate 78 fee schedule average rate 103 fee schedule average rate 77 fee schedule average rate 15 fee schedule average rate 64 fee schedule average rate 50 fee schedule average rate 49 fee schedule average rate 78 fee schedule average rate 77 fee schedule average rate INTIAL HOSPITAL CARE (50 MIN) 99222 RC facility outpatient 260 44 165 44 fee schedule average rate 165 fee schedule average rate 106 fee schedule average rate 97 fee schedule average rate 111 fee schedule average rate 81 fee schedule average rate 125 fee schedule average rate 90 fee schedule average rate 67 fee schedule average rate 123 fee schedule average rate INTIAL HOSPITAL CARE (70 MIN) 99223 RC facility outpatient 280 56 230 56 fee schedule average rate 169 fee schedule average rate 230 fee schedule average rate 157 fee schedule average rate 71 fee schedule average rate 170 fee schedule average rate 77 fee schedule average rate 113 fee schedule average rate 161 fee schedule average rate 116 fee schedule average rate 151 fee schedule average rate 93 fee schedule average rate 165 fee schedule average rate 137 fee schedule average rate 108 fee schedule average rate 98 fee schedule average rate 105 fee schedule average rate 161 fee schedule average rate SUBSEQ CARE (15 MIN) 99231 RC facility outpatient 140 20 75 63 fee schedule average rate 36 fee schedule average rate 30 fee schedule average rate 34 fee schedule average rate 54 fee schedule average rate 43 fee schedule average rate 39 fee schedule average rate 75 fee schedule average rate 39 fee schedule average rate 40 fee schedule average rate 33 fee schedule average rate 40 fee schedule average rate 32 fee schedule average rate 38 fee schedule average rate 20 fee schedule average rate 38 fee schedule average rate 37 fee schedule average rate 40 fee schedule average rate 44 fee schedule average rate 39 fee schedule average rate SUBSEQ CARE (25 MIN) 99232 RC facility outpatient 160 37 95 95 fee schedule average rate 88 fee schedule average rate 88 fee schedule average rate 56 fee schedule average rate 59 fee schedule average rate 79 fee schedule average rate 74 fee schedule average rate 55 fee schedule average rate 65 fee schedule average rate 53 fee schedule average rate 37 fee schedule average rate 60 fee schedule average rate 75 fee schedule average rate 74 fee schedule average rate SUBSEQ CARE (35 MIN) 99233 RC facility outpatient 180 52 114 114 fee schedule average rate 84 fee schedule average rate 57 fee schedule average rate 52 fee schedule average rate DISCHARGE DAY MGMT <30 99238 RC facility outpatient 160 37 118 118 fee schedule average rate 64 fee schedule average rate 56 fee schedule average rate 53 fee schedule average rate 48 fee schedule average rate 52 fee schedule average rate 64 fee schedule average rate 104 fee schedule average rate 64 fee schedule average rate 65 fee schedule average rate 46 fee schedule average rate 51 fee schedule average rate 79 fee schedule average rate 37 fee schedule average rate 62 fee schedule average rate 95 fee schedule average rate 76 fee schedule average rate 64 fee schedule average rate DISCHARGE DAY MGMT >30 99239 RC facility outpatient 160 53 85 85 fee schedule average rate 81 fee schedule average rate 67 fee schedule average rate 53 fee schedule average rate