hospital_name last_updated_on version hospital_location hospital_address license_number|AR "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." "Valley Behavioral Health System, LLC" 5/31/2024 2.0.0 "Barling, Arkansas" 10301 Mayo Drive license_ AR5044 | AR 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 HEALTH CARE OPTIONS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AARP HEALTH CARE OPTIONS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AARP HEALTH CARE OPTIONS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AARP HEALTH CARE OPTIONS]|[plan_HMO/PPO] standard_charge|[payer_AARP HEALTH CARE OPTIONS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AARP HEALTH CARE OPTIONS]|[Plan_HMO/PPO] standard_charge|[payer_AARP ]|[plan_ MEDICARE ADVANTAGE]|negotiated_dollar standard_charge|[payer_AARP ]|[plan_ MEDICARE ADVANTAGE] |negotiated_percentage standard_charge|[payer_AARP ]|[plan_ MEDICARE ADVANTAGE] |negotiated_algorithm estimated_amount|[payer_AARP ]|[plan_ MEDICARE ADVANTAGE] standard_charge|[payer_AARP ]|[plan_ MEDICARE ADVANTAGE] |methodology additional_payer_notes |[payer_AARP ]|[Plan_ MEDICARE ADVANTAGE] standard_charge|[payer_AETNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA]|[plan_HMO/PPO] standard_charge|[payer_AETNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AETNA]|[Plan_HMO/PPO] standard_charge|[payer_AETNA 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_ALLWELL MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALLWELL MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALLWELL MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALLWELL MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ALLWELL MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO] standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AMBETTER OF ARKANSAS]|[Plan_HMO/PPO] standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO PHYSICIAN] |negotiated_percentage standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO PHYSICIAN] |negotiated_algorithm estimated_amount|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO PHYSICIAN] standard_charge|[payer_AMBETTER OF ARKANSAS]|[plan_HMO/PPO PHYSICIAN] |methodology additional_payer_notes |[payer_AMBETTER OF ARKANSAS]|[Plan_HMO/PPO PHYSICIAN] standard_charge|[payer_ANTHEM MEDIBLUE PLUS CA]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ANTHEM MEDIBLUE PLUS CA]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ANTHEM MEDIBLUE PLUS CA]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ANTHEM MEDIBLUE PLUS CA]|[plan_MANAGED MEDICARE] standard_charge|[payer_ANTHEM MEDIBLUE PLUS CA]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ANTHEM MEDIBLUE PLUS CA]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AR MEDICAID 21 OVER]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_AR MEDICAID 21 OVER]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_AR MEDICAID 21 OVER]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_AR MEDICAID 21 OVER]|[plan_MEDICAID ] standard_charge|[payer_AR MEDICAID 21 OVER]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_AR MEDICAID 21 OVER]|[Plan_MEDICAID ] standard_charge|[payer_AR MEDICAID PENDING]|[plan_PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_AR MEDICAID PENDING]|[plan_PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_AR MEDICAID PENDING]|[plan_PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_AR MEDICAID PENDING]|[plan_PENDING MEDICAID] standard_charge|[payer_AR MEDICAID PENDING]|[plan_PENDING MEDICAID] |methodology additional_payer_notes |[payer_AR MEDICAID PENDING]|[Plan_PENDING MEDICAID] standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID ] standard_charge|[payer_ARKANSAS MEDICAID]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_ARKANSAS MEDICAID]|[Plan_MEDICAID ] standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ARKANSAS TOTAL CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_ARKANSAS TOTAL CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ARKANSAS TOTAL CARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BCBS ARKANSAS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS ARKANSAS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS ARKANSAS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS ARKANSAS]|[plan_BLUE CROSS] standard_charge|[payer_BCBS ARKANSAS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS ARKANSAS]|[Plan_BLUE CROSS] 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 MARKETPLACE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS MARKETPLACE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS MARKETPLACE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS MARKETPLACE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS MARKETPLACE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS MARKETPLACE]|[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_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 ADMINISTRATIVE SY]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BENEFIT ADMINISTRATIVE SY]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BENEFIT ADMINISTRATIVE SY]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BENEFIT ADMINISTRATIVE SY]|[plan_COMMERCIAL] standard_charge|[payer_BENEFIT ADMINISTRATIVE SY]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BENEFIT ADMINISTRATIVE SY]|[Plan_COMMERCIAL] standard_charge|[payer_CARE IMPROVEMENT OPTUM]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARE IMPROVEMENT OPTUM]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CARE IMPROVEMENT OPTUM]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CARE IMPROVEMENT OPTUM]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARE IMPROVEMENT OPTUM]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CARE IMPROVEMENT OPTUM]|[Plan_MANAGED MEDICARE] standard_charge|[payer_CARESOURCE PASSE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CARESOURCE PASSE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CARESOURCE PASSE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CARESOURCE PASSE]|[plan_MANAGED MEDICAID] standard_charge|[payer_CARESOURCE PASSE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CARESOURCE PASSE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CENTURY HEALTHCARE LLC]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_CENTURY HEALTHCARE LLC]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CENTURY HEALTHCARE LLC]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CENTURY HEALTHCARE LLC]|[plan_COMMERCIAL] standard_charge|[payer_CENTURY HEALTHCARE LLC]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_CENTURY HEALTHCARE LLC]|[Plan_COMMERCIAL] standard_charge|[payer_CHAMPUS TRICARE PGBA]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_CHAMPUS TRICARE PGBA]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_CHAMPUS TRICARE PGBA]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_CHAMPUS TRICARE PGBA]|[plan_TRICARE] standard_charge|[payer_CHAMPUS TRICARE PGBA]|[plan_TRICARE] |methodology additional_payer_notes |[payer_CHAMPUS TRICARE PGBA]|[Plan_TRICARE] 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_CHEROKEE NATION OFFICE]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CHEROKEE NATION OFFICE]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_CHEROKEE NATION OFFICE]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_CHEROKEE NATION OFFICE]|[plan_LOCAL GOVT] standard_charge|[payer_CHEROKEE NATION OFFICE]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_CHEROKEE NATION OFFICE]|[Plan_LOCAL GOVT] standard_charge|[payer_CHOCTAW NATION HOSPITAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CHOCTAW NATION HOSPITAL]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CHOCTAW NATION HOSPITAL]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CHOCTAW NATION HOSPITAL]|[plan_HMO/PPO] standard_charge|[payer_CHOCTAW NATION HOSPITAL]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CHOCTAW NATION HOSPITAL]|[Plan_HMO/PPO] standard_charge|[payer_CHOICE BENEFITS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CHOICE BENEFITS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CHOICE BENEFITS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CHOICE BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_CHOICE BENEFITS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CHOICE BENEFITS]|[Plan_HMO/PPO] standard_charge|[payer_CHRISTIAN BROS EMP BENEFT]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_CHRISTIAN BROS EMP BENEFT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CHRISTIAN BROS EMP BENEFT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CHRISTIAN BROS EMP BENEFT]|[plan_COMMERCIAL] standard_charge|[payer_CHRISTIAN BROS EMP BENEFT]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_CHRISTIAN BROS EMP BENEFT]|[Plan_COMMERCIAL] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CIGNA BEHAVIORAL HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA BEHAVIORAL HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_CIGNA CHOICE BENEFITS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA CHOICE BENEFITS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA CHOICE BENEFITS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA CHOICE BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_CIGNA CHOICE BENEFITS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA CHOICE BENEFITS]|[Plan_HMO/PPO] standard_charge|[payer_CIGNA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_COMPSYCH CORPORATION]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_COMPSYCH CORPORATION]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_COMPSYCH CORPORATION]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_COMPSYCH CORPORATION]|[plan_COMMERCIAL] standard_charge|[payer_COMPSYCH CORPORATION]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_COMPSYCH CORPORATION]|[Plan_COMMERCIAL] standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CORESOURCE]|[plan_HMO/PPO] standard_charge|[payer_CORESOURCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CORESOURCE]|[Plan_HMO/PPO] standard_charge|[payer_COUNSELING ASSOCIATES]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_COUNSELING ASSOCIATES]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_COUNSELING ASSOCIATES]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_COUNSELING ASSOCIATES]|[plan_LOCAL GOVT] standard_charge|[payer_COUNSELING ASSOCIATES]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_COUNSELING ASSOCIATES]|[Plan_LOCAL GOVT] standard_charge|[payer_COVENTRY HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_COVENTRY HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_COVENTRY HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COVENTRY HEALTH]|[plan_HMO/PPO] standard_charge|[payer_COVENTRY HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_COVENTRY HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_COVENTRY MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_COVENTRY MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_COVENTRY MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_COVENTRY MANAGED MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_COVENTRY MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_COVENTRY MANAGED MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_COX HEALT PLANS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_COX HEALT PLANS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_COX HEALT PLANS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COX HEALT PLANS]|[plan_HMO/PPO] standard_charge|[payer_COX HEALT PLANS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_COX HEALT PLANS]|[Plan_HMO/PPO] standard_charge|[payer_COX HEALTH PLANS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_COX HEALTH PLANS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_COX HEALTH PLANS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_COX HEALTH PLANS]|[plan_HMO/PPO] standard_charge|[payer_COX HEALTH PLANS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_COX HEALTH PLANS]|[Plan_HMO/PPO] standard_charge|[payer_DCFS CHICAGO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DCFS CHICAGO]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DCFS CHICAGO]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DCFS CHICAGO]|[plan_LOCAL GOVT] standard_charge|[payer_DCFS CHICAGO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DCFS CHICAGO]|[Plan_LOCAL GOVT] standard_charge|[payer_DHS ARKANSAS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DHS ARKANSAS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DHS ARKANSAS]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DHS ARKANSAS]|[plan_LOCAL GOVT] standard_charge|[payer_DHS ARKANSAS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DHS ARKANSAS]|[Plan_LOCAL GOVT] standard_charge|[payer_DHS OKLAHOMA]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DHS OKLAHOMA]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DHS OKLAHOMA]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DHS OKLAHOMA]|[plan_LOCAL GOVT] standard_charge|[payer_DHS OKLAHOMA]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DHS OKLAHOMA]|[Plan_LOCAL GOVT] standard_charge|[payer_DHS OUT OF STATE]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DHS OUT OF STATE]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DHS OUT OF STATE]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DHS OUT OF STATE]|[plan_LOCAL GOVT] standard_charge|[payer_DHS OUT OF STATE]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_DHS OUT OF STATE]|[Plan_LOCAL GOVT] standard_charge|[payer_EHN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_EHN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_EHN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_EHN]|[plan_HMO/PPO] standard_charge|[payer_EHN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_EHN]|[Plan_HMO/PPO] standard_charge|[payer_EMPLOYERS HEALTH CHOICE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_EMPLOYERS HEALTH CHOICE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_EMPLOYERS HEALTH CHOICE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_EMPLOYERS HEALTH CHOICE]|[plan_HMO/PPO] standard_charge|[payer_EMPLOYERS HEALTH CHOICE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_EMPLOYERS HEALTH CHOICE]|[Plan_HMO/PPO] standard_charge|[payer_EMPOWER HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_EMPOWER HEALTHCARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_EMPOWER HEALTHCARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_EMPOWER HEALTHCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_EMPOWER HEALTHCARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_EMPOWER HEALTHCARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_ENTER NO PAY INS HERE]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_ENTER NO PAY INS HERE]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_ENTER NO PAY INS HERE]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_ENTER NO PAY INS HERE]|[plan_MEDICAID ] standard_charge|[payer_ENTER NO PAY INS HERE]|[plan_MEDICAID ] |methodology additional_payer_notes |[payer_ENTER NO PAY INS HERE]|[Plan_MEDICAID ] 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_GPA GROUP AND PENSION ADM]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GPA GROUP AND PENSION ADM]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GPA GROUP AND PENSION ADM]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GPA GROUP AND PENSION ADM]|[plan_HMO/PPO] standard_charge|[payer_GPA GROUP AND PENSION ADM]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_GPA GROUP AND PENSION ADM]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHCHOICE]|[plan_HMO/PPO] standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHCHOICE]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE-AETNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSCOPE-AETNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHSCOPE-AETNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHSCOPE-AETNA]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE-AETNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHSCOPE-AETNA]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE-CIGNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSCOPE-CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHSCOPE-CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHSCOPE-CIGNA]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE-CIGNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHSCOPE-CIGNA]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE-UHC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSCOPE-UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHSCOPE-UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHSCOPE-UHC]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE-UHC]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHSCOPE-UHC]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHSPRINGS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HEALTHSPRINGS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HEALTHSPRINGS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HEALTHSPRINGS]|[plan_MANAGED MEDICARE] standard_charge|[payer_HEALTHSPRINGS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HEALTHSPRINGS]|[Plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD]|[plan_Managed Medicare]|negotiated_dollar standard_charge|[payer_HUMANA GOLD]|[plan_Managed Medicare]|negotiated_percentage standard_charge|[payer_HUMANA GOLD]|[plan_Managed Medicare]|negotiated_algorithm estimated_amount|[payer_HUMANA GOLD]|[plan_Managed Medicare] standard_charge|[payer_HUMANA GOLD]|[plan_Managed Medicare]|methodology additional_payer_notes |[payer_HUMANA GOLD]|[plan_Managed Medicare] 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_KAISER PERMANENTE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] standard_charge|[payer_KAISER PERMANENTE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_KAISER PERMANENTE]|[Plan_COMMERCIAL] standard_charge|[payer_LINECO BENEFIT FUND]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_LINECO BENEFIT FUND]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_LINECO BENEFIT FUND]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_LINECO BENEFIT FUND]|[plan_HMO/PPO] standard_charge|[payer_LINECO BENEFIT FUND]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_LINECO BENEFIT FUND]|[Plan_HMO/PPO] standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MAGELLAN BEHAVIORAL HEALT]|[Plan_HMO/PPO] standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE]|[Plan_MEDICARE] standard_charge|[payer_MEDIPAK ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MEDIPAK ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MEDIPAK ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDIPAK ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MEDIPAK ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MEDIPAK ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] standard_charge|[payer_MERITAIN HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MERITAIN HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_MHNET]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MHNET]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MHNET]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MHNET]|[plan_MANAGED MEDICARE] standard_charge|[payer_MHNET]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MHNET]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MHNET BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MHNET BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MHNET BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MHNET BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_MHNET BEHAVIORAL HEALTH]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MHNET BEHAVIORAL HEALTH]|[Plan_MANAGED 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 MANAGED MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MANAGED MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MISC MANAGED MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MISC MANAGED MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_MISC MANAGED MEDICAID]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MISC MANAGED MEDICAID]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MO ANTHEM BCBS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_MO ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_MO ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_MO ANTHEM BCBS]|[plan_BLUE CROSS] standard_charge|[payer_MO ANTHEM BCBS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_MO ANTHEM BCBS]|[Plan_BLUE CROSS] standard_charge|[payer_MO ANTHEM MEDIBLUE DUAL]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MO ANTHEM MEDIBLUE DUAL]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MO ANTHEM MEDIBLUE DUAL]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MO ANTHEM MEDIBLUE DUAL]|[plan_MANAGED MEDICARE] standard_charge|[payer_MO ANTHEM MEDIBLUE DUAL]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MO ANTHEM MEDIBLUE DUAL]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MO BCBS ANTHEM]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_MO BCBS ANTHEM]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_MO BCBS ANTHEM]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_MO BCBS ANTHEM]|[plan_BLUE CROSS] standard_charge|[payer_MO BCBS ANTHEM]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_MO BCBS ANTHEM]|[Plan_BLUE CROSS] standard_charge|[payer_MUNICIPAL HEALTH BENEFITS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MUNICIPAL HEALTH BENEFITS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MUNICIPAL HEALTH BENEFITS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MUNICIPAL HEALTH BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_MUNICIPAL HEALTH BENEFITS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MUNICIPAL HEALTH BENEFITS]|[Plan_HMO/PPO] standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] standard_charge|[payer_MUTUAL OF OMAHA]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MUTUAL OF OMAHA]|[Plan_COMMERCIAL] standard_charge|[payer_NOVASYS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_NOVASYS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_NOVASYS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_NOVASYS]|[plan_HMO/PPO] standard_charge|[payer_NOVASYS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_NOVASYS]|[Plan_HMO/PPO] standard_charge|[payer_OK MEDICAID PENDING]|[plan_PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_OK MEDICAID PENDING]|[plan_PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_OK MEDICAID PENDING]|[plan_PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_OK MEDICAID PENDING]|[plan_PENDING MEDICAID] standard_charge|[payer_OK MEDICAID PENDING]|[plan_PENDING MEDICAID] |methodology additional_payer_notes |[payer_OK MEDICAID PENDING]|[Plan_PENDING MEDICAID] standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OKLAHOMA MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OKLAHOMA MEDICAID EDS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OKLAHOMA MEDICAID EDS]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OKLAHOMA MEDICAID EDS]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OKLAHOMA MEDICAID EDS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OKLAHOMA MEDICAID EDS]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OKLAHOMA MEDICAID EDS]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OPTUM OOS EXCHANGE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_OPTUM OOS EXCHANGE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_OPTUM OOS EXCHANGE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_OPTUM OOS EXCHANGE]|[plan_COMMERCIAL] standard_charge|[payer_OPTUM OOS EXCHANGE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_OPTUM OOS EXCHANGE]|[Plan_COMMERCIAL] standard_charge|[payer_OUT OF STATE MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OUT OF STATE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_OUT OF STATE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_OUT OF STATE MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OUT OF STATE MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OUT OF STATE MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OZARK GUIDANCE CENTER]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OZARK GUIDANCE CENTER]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_OZARK GUIDANCE CENTER]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_OZARK GUIDANCE CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_OZARK GUIDANCE CENTER]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_OZARK GUIDANCE CENTER]|[Plan_LOCAL GOVT] standard_charge|[payer_PROFESSIONAL COUNSELING]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_PROFESSIONAL COUNSELING]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_PROFESSIONAL COUNSELING]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_PROFESSIONAL COUNSELING]|[plan_LOCAL GOVT] standard_charge|[payer_PROFESSIONAL COUNSELING]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_PROFESSIONAL COUNSELING]|[Plan_LOCAL GOVT] standard_charge|[payer_QUALCHOICE OF ARKANSAS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_QUALCHOICE OF ARKANSAS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_QUALCHOICE OF ARKANSAS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_QUALCHOICE OF ARKANSAS]|[plan_HMO/PPO] standard_charge|[payer_QUALCHOICE OF ARKANSAS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_QUALCHOICE OF ARKANSAS]|[Plan_HMO/PPO] standard_charge|[payer_SISCO]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_SISCO]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_SISCO]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SISCO]|[plan_COMMERCIAL] standard_charge|[payer_SISCO]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_SISCO]|[Plan_COMMERCIAL] standard_charge|[payer_SUMMIT COMMUNITY CARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUMMIT COMMUNITY CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUMMIT COMMUNITY CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SUMMIT COMMUNITY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_SUMMIT COMMUNITY CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUMMIT COMMUNITY CARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_THE KEMPTON GROUP ADM INC]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_THE KEMPTON GROUP ADM INC]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_THE KEMPTON GROUP ADM INC]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_THE KEMPTON GROUP ADM INC]|[plan_COMMERCIAL] standard_charge|[payer_THE KEMPTON GROUP ADM INC]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_THE KEMPTON GROUP ADM INC]|[Plan_COMMERCIAL] standard_charge|[payer_TRIBUTE HEALTHPLAN]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_TRIBUTE HEALTHPLAN]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_TRIBUTE HEALTHPLAN]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_TRIBUTE HEALTHPLAN]|[plan_MANAGED MEDICARE] standard_charge|[payer_TRIBUTE HEALTHPLAN]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_TRIBUTE HEALTHPLAN]|[Plan_MANAGED MEDICARE] 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 SOUTH]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE SOUTH]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE SOUTH]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE SOUTH]|[plan_TRICARE] standard_charge|[payer_TRICARE SOUTH]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE SOUTH]|[Plan_TRICARE] standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_TRUSTMARK]|[plan_HMO/PPO] standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_TRUSTMARK]|[Plan_HMO/PPO] standard_charge|[payer_UBH / OPTUM]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH / OPTUM]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UBH / OPTUM]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UBH / OPTUM]|[plan_HMO/PPO] standard_charge|[payer_UBH / OPTUM]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UBH / OPTUM]|[Plan_HMO/PPO] standard_charge|[payer_UBH MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UBH MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UBH MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UBH MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UBH MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHC COMM AND STATE OF LA]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_UHC COMM AND STATE OF LA]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_UHC COMM AND STATE OF LA]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_UHC COMM AND STATE OF LA]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_UHC COMM AND STATE OF LA]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_UHC COMM AND STATE OF LA]|[Plan_MEDICAID: OUT OF STATE] 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 TEXAS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_UHC MEDICAID TEXAS]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_UHC MEDICAID TEXAS]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_UHC MEDICAID TEXAS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_UHC MEDICAID TEXAS]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_UHC MEDICAID TEXAS]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_UHC MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UMR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UMR]|[Plan_HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE]|[plan_HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE]|[Plan_HMO/PPO] standard_charge|[payer_VETERANS ADMINISTRATION]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VETERANS ADMINISTRATION]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VETERANS ADMINISTRATION]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VETERANS ADMINISTRATION]|[plan_VETERANS ADMIN] standard_charge|[payer_VETERANS ADMINISTRATION]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VETERANS ADMINISTRATION]|[Plan_VETERANS ADMIN] 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 AR GUIDANCE CTR]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_WESTERN AR GUIDANCE CTR]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_WESTERN AR GUIDANCE CTR]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_WESTERN AR GUIDANCE CTR]|[plan_LOCAL GOVT] standard_charge|[payer_WESTERN AR GUIDANCE CTR]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_WESTERN AR GUIDANCE CTR]|[Plan_LOCAL GOVT] standard_charge|[payer_WORKERS COMP]|[plan_WORKERS COMP]|negotiated_dollar standard_charge|[payer_WORKERS COMP]|[plan_WORKERS COMP] |negotiated_percentage standard_charge|[payer_WORKERS COMP]|[plan_WORKERS COMP] |negotiated_algorithm estimated_amount|[payer_WORKERS COMP]|[plan_WORKERS COMP] standard_charge|[payer_WORKERS COMP]|[plan_WORKERS COMP] |methodology additional_payer_notes |[payer_WORKERS COMP]|[Plan_WORKERS COMP] additional_generic_notes ROOM AND BOARD ADOL ACUTE 114 RC facility inpatient 1800 700 400 3450 760 per diem 979 per diem 979 per diem 840 per diem 738 per diem 717 per diem 717 per diem 717 per diem 717 per diem 759 per diem 759 per diem 798 per diem 759 per diem 1000 per diem 700 per diem 703 per diem 717 per diem 1725 per diem 620 per diem 768 per diem 950 per diem 950 per diem 1058 per diem 1325 per diem 1058 per diem 1058 per diem 980 per diem 738 per diem 887 per diem 400 per diem 814 per diem 785 per diem 980 per diem 1800 per diem 717 per diem 597 per diem 1800 per diem 950 per diem 903 per diem 717 per diem 664 per diem 1325 per diem 1725 per diem 944 per diem 887 per diem 980 per diem 703 per diem 960 per diem 2085 per diem 1000 per diem 736 per diem 941 per diem 785 per diem 785 per diem 3450 per diem 1800 per diem 838 per diem 1000 per diem 1800 per diem 814 per diem 597 per diem 597 per diem 597 per diem 738 per diem 1725 per diem 400 per diem 400 per diem 924 per diem 1800 per diem 717 per diem 1800 per diem 673 per diem 704 per diem 620 per diem 914 per diem 738 per diem 738 per diem 738 per diem 738 per diem 1800 per diem 738 per diem 738 per diem 738 per diem 738 per diem 620 per diem 550 per diem 1800 per diem ROOM AND BOARD ADOL RTU 129 RC facility inpatient 1100 450 220 1100 577 per diem 725 per diem 619 per diem 508 per diem 508 per diem 508 per diem 508 per diem 750 per diem 450 per diem 619 per diem 812 per diem 812 per diem 812 per diem 655 per diem 752 per diem 619 per diem 1100 per diem 903 per diem 619 per diem 390 per diem 544 per diem 220 per diem 695 per diem 585 per diem 1020 per diem 530 per diem 1000 per diem 520 per diem 363 per diem 619 per diem 560 per diem 560 per diem 560 per diem 560 per diem 560 per diem 560 per diem ROOM AND BOARD CHILD RTU 129 RC facility inpatient 1100 450 220 1100 577 per diem 725 per diem 619 per diem 508 per diem 508 per diem 508 per diem 508 per diem 750 per diem 450 per diem 619 per diem 812 per diem 812 per diem 812 per diem 655 per diem 752 per diem 619 per diem 1100 per diem 903 per diem 619 per diem 390 per diem 544 per diem 220 per diem 695 per diem 585 per diem 1020 per diem 530 per diem 1000 per diem 520 per diem 363 per diem 619 per diem 560 per diem 560 per diem 560 per diem 560 per diem 560 per diem 560 per diem PARTIAL HOSPITAL PROGRAM ACT THERAPY GRP 904 RC facility outpatient 100 125 125 125 per diem PARTIAL HOSPITAL PROGRAM GRP ACTIVITY 904 RC facility outpatient 125 125 125 125 per diem INTENSIVE OUTPATIENT PROGRAM CHARGE 905 RC facility outpatient 375 190 126 375 141 per diem 196 per diem 196 per diem 126 per diem 126 per diem 375 per diem 375 per diem 375 per diem 375 per diem 200 per diem 200 per diem 200 per diem 200 per diem 250 per diem 128 per diem 375 per diem 225 per diem 200 per diem 225 per diem 187 per diem 187 per diem 263 per diem 200 per diem 375 per diem 165 per diem 165 per diem 187 per diem 141 per diem 205 per diem 203 per diem 250 per diem 205 per diem 209 per diem 195 per diem 375 per diem 200 per diem 200 per diem 200 per diem 175 per diem 375 per diem 375 per diem 139 per diem 375 per diem 200 per diem 141 per diem 141 per diem 141 per diem 141 per diem 141 per diem 141 per diem 141 per diem 141 per diem 205 per diem 375 per diem PARTIAL HOSPITAL PROGRAM PROGRAM CHARGE 912 RC facility outpatient 500 260 190 700 376 per diem 432 per diem 432 per diem 209 per diem 315 per diem 500 per diem 500 per diem 500 per diem 500 per diem 286 per diem 330 per diem 286 per diem 286 per diem 450 per diem 350 per diem 500 per diem 307 per diem 402 per diem 434 per diem 263 per diem 330 per diem 402 per diem 239 per diem 360 per diem 236 per diem 700 per diem 500 per diem 330 per diem 330 per diem 330 per diem 300 per diem 500 per diem 500 per diem 500 per diem 190 per diem 235 per diem 376 per diem 376 per diem 376 per diem 376 per diem 376 per diem 376 per diem 376 per diem 376 per diem 190 per diem 500 per diem INTENSIVE OUTPATIENT PROGRAM IND THERAPY 60M 914 RC facility outpatient 110 120 125 125 per diem 121 per diem 120 per diem PARTIAL HOSPITAL PROGRAM IND THERAPY 60M 914 RC facility outpatient 125 120 125 125 per diem 121 per diem 120 per diem INTENSIVE OUTPATIENT PROGRAM MCR PROCESS GRP1 915 RC facility outpatient 125 173 500 209 per diem 500 per diem 263 per diem 203 per diem 360 per diem 235 per diem 236 per diem 350 per diem 250 per diem 175 per diem 500 per diem 173 per diem 437 per diem 350 per diem 379 per diem PARTIAL HOSPITAL PROGRAM GROUP THERAPY 915 RC facility outpatient 75 173 500 209 per diem 500 per diem 263 per diem 239 per diem 360 per diem 235 per diem 236 per diem 350 per diem 250 per diem 175 per diem 500 per diem 173 per diem 437 per diem 350 per diem 379 per diem Psychiatric diagnostic evaluation 90791 RC facility both 332 75 168 75 fee schedule 122 fee schedule 168 fee schedule 114 fee schedule 145 fee schedule 98 fee schedule 124 fee schedule 75 fee schedule 95 fee schedule Psychiatric diagnostic evaluation with medical services 90792 RC facility both 405 154 154 154 fee schedule "Subsequent hospital inpatient or observation care, per day, straightforward or low medical decision making" 99231 RC facility both 120 25 46 46 fee schedule 25 fee schedule 41 fee schedule 31 fee schedule 39 fee schedule 27 fee schedule 32 fee schedule "Subsequent hospital inpatient or observation care, per day, moderate medical decision making" 99232 RC facility both 130 35 76 35 fee schedule 62 fee schedule 76 fee schedule 73 fee schedule 60 fee schedule 76 fee schedule 44 fee schedule 62 fee schedule 35 fee schedule 46 fee schedule Hospital discharge day management; 30 minutes or less 99238 RC facility both 160 49 77 74 fee schedule 77 fee schedule 62 fee schedule 63 fee schedule 60 fee schedule 49 fee schedule