hospital_name last_updated_on version hospital_location hospital_address license_number|OH "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." Ohio Hospitalof Psychiatry 5/31/2024 2.0.0 "Columbus, Ohio" 35031 23 Mile Road license_2479-07-01 | OH TRUE description code|1 code|1|type setting drug_unit_of_measurement drug_type_of_measurement standard_charge|gross standard_charge|discounted_cash modifiers standard_charge|[payer_3HAB]|[plan_WORKERS COMP]|negotiated_dollar standard_charge|[payer_3HAB]|[plan_WORKERS COMP]|negotiated_percentage standard_charge|[payer_3HAB]|[plan_WORKERS COMP]|negotiated_algorithm estimated_amount|[payer_3HAB]|[plan_WORKERS COMP] standard_charge|[payer_3HAB]|[plan_WORKERS COMP]|methodology additional_payer_notes |[payer_3HAB]|[plan_WORKERS COMP] 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_ADAMH ALLEN CO ]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH ALLEN CO ]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH ALLEN CO ]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH ALLEN CO ]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH ALLEN CO ]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH ALLEN CO ]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH ALS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH ALS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH ALS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH ALS]|[plan_LOCAL GOVT]|[plan_HMO/PPO] standard_charge|[payer_ADAMH ALS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH ALS]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH ASHLAND COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH ASHLAND COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ADAMH ASHLAND COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH ASHLAND COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH ASHLAND COUNTY]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH ASHLAND COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH BELMONT]|[plan_lOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH BELMONT]|[plan_lOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH BELMONT]|[plan_lOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH BELMONT]|[plan_lOCAL GOVT] standard_charge|[payer_ADAMH BELMONT]|[plan_lOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH BELMONT]|[plan_lOCAL GOVT] standard_charge|[payer_ADAMH BOARD FRANKLIN CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH BOARD FRANKLIN CO]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH BOARD FRANKLIN CO]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH BOARD FRANKLIN CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH BOARD FRANKLIN CO]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH BOARD FRANKLIN CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH BOARD OF MONTGOMERY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH BOARD OF MONTGOMERY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH BOARD OF MONTGOMERY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH BOARD OF MONTGOMERY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH BOARD OF MONTGOMERY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH BOARD OF MONTGOMERY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH BOARD PAINT VALLEY]|[LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH BOARD PAINT VALLEY]|[LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH BOARD PAINT VALLEY]|[LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH BOARD PAINT VALLEY]|[LOCAL GOVT] standard_charge|[payer_ADAMH BOARD PAINT VALLEY]|[LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH BOARD PAINT VALLEY]|[LOCAL GOVT] standard_charge|[payer_ADAMH FAIRFIELD COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH FAIRFIELD COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH FAIRFIELD COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH FAIRFIELD COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH FAIRFIELD COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH FAIRFIELD COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH HANCOCK COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH HANCOCK COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH HANCOCK COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH HANCOCK COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH HANCOCK COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH HANCOCK COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH LICKING & KNOX CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH LICKING & KNOX CO]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH LICKING & KNOX CO]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH LICKING & KNOX CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH LICKING & KNOX CO]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_ADAMH LICKING & KNOX CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH LOGAN/CHAMPAIGN CO]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH LOGAN/CHAMPAIGN CO]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH LOGAN/CHAMPAIGN CO]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH LOGAN/CHAMPAIGN CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH LOGAN/CHAMPAIGN CO]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH LOGAN/CHAMPAIGN CO]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH MARION COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH MARION COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH MARION COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH MARION COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH MARION COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH MARION COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH MEIGS COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH MEIGS COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH MEIGS COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH MEIGS COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH MEIGS COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH MEIGS COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH TRI-COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH TRI-COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH TRI-COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH TRI-COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH TRI-COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH TRI-COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH WASHINGTON COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ADAMH WASHINGTON COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ADAMH WASHINGTON COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ADAMH WASHINGTON COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ADAMH WASHINGTON COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ADAMH WASHINGTON COUNTY]|[plan_LOCAL GOVT] 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 BETTER HEALTH MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH MCD]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH MCD]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH MCD]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_AETNA BETTER HEALTH MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH WV]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH WV]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH WV]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH WV]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH WV]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_AETNA BETTER HEALTH WV]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA BETTER MCR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_AETNA BETTER MCR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_AETNA BETTER MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER MCR]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_AETNA BETTER MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA BH PA MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BH PA MCD]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_AETNA BH PA MCD]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_AETNA BH PA MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_AETNA BH PA MCD]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_AETNA BH PA MCD]|[plan_MANAGED MEDICAID] 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_ALL SAVERS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALL SAVERS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_ALL SAVERS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_ALL SAVERS]|[plan_HMO/PPO] standard_charge|[payer_ALL SAVERS]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_ALL SAVERS]|[plan_HMO/PPO] standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] standard_charge|[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALLIED BENEFIT SYSTEMS]|[plan_HMO/PPO] standard_charge|[payer_ALTERNATIVE PATHS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ALTERNATIVE PATHS]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ALTERNATIVE PATHS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ALTERNATIVE PATHS]|[plan_LOCAL GOVT] standard_charge|[payer_ALTERNATIVE PATHS]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ALTERNATIVE PATHS]|[plan_LOCAL GOVT] standard_charge|[payer_AMBETTER]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AMBETTER]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_AMBETTER]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_AMBETTER]|[plan_HMO/PPO] standard_charge|[payer_AMBETTER]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_AMBETTER]|[plan_HMO/PPO] standard_charge|[payer_AMBETTER MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMBETTER MCR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_AMBETTER MCR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_AMBETTER MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMBETTER MCR]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_AMBETTER MCR]|[plan_MANAGED MEDICARE] 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_AULTCARE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AULTCARE]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_AULTCARE]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_AULTCARE]|[plan_COMMERCIAL] standard_charge|[payer_AULTCARE]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_AULTCARE]|[plan_COMMERCIAL] standard_charge|[payer_BAS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BAS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_BAS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_BAS]|[plan_HMO/PPO] standard_charge|[payer_BAS]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_BAS]|[plan_HMO/PPO] 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 MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BCBS MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_BCBS MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_BCBS MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_BCBS MEDICAID]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_BCBS MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_BCBS OHIO]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OHIO]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS OHIO]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS OHIO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OHIO]|[plan_BLUE CROSS]|methodology additional_payer_notes |[payer_BCBS OHIO]|[plan_BLUE CROSS] standard_charge|[payer_BCBS SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_BCBS SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_BCBS SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_BCBS SENIOR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO] standard_charge|[payer_BHP]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BHP]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_BHP]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_BHP]|[plan_LOCAL GOVT] standard_charge|[payer_BHP]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_BHP]|[plan_LOCAL GOVT] standard_charge|[payer_BUCKEYE HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BUCKEYE HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_BUCKEYE HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_BUCKEYE HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_BUCKEYE HEALTH PLAN]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_BUCKEYE HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CARELON BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CARELON BEHAVIORAL HEALTH]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_CARELON BEHAVIORAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CARESOURCE MARKETPLACE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CARESOURCE MARKETPLACE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_CARESOURCE MARKETPLACE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CARESOURCE MARKETPLACE]|[plan_HMO/PPO] standard_charge|[payer_CARESOURCE MARKETPLACE]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_CARESOURCE MARKETPLACE]|[plan_HMO/PPO] standard_charge|[payer_CARESOURCE MCR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CARESOURCE MCR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_CARESOURCE MCR ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_CARESOURCE MCR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARESOURCE MCR ADVANTAGE]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_CARESOURCE MCR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARESOURCE MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CARESOURCE MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_CARESOURCE MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_CARESOURCE MEDICAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_CARESOURCE MEDICAID]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_CARESOURCE MEDICAID]|[plan_MANAGED MEDICAID] 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]|[plan_HMO/PPO] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|methodology additional_payer_notes |[payer_CHAMPVA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMPVA-IP]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMPVA-IP]|[plan_VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_CHAMPVA-IP]|[plan_VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_CHAMPVA-IP]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMPVA-IP]|[plan_VETERANS ADMIN]|methodology additional_payer_notes |[payer_CHAMPVA-IP]|[plan_VETERANS ADMIN] 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_CLARK AND MADISON COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CLARK AND MADISON COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_CLARK AND MADISON COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_CLARK AND MADISON COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_CLARK AND MADISON COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_CLARK AND MADISON COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_COMMUNICARE ADV]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_COMMUNICARE ADV]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_COMMUNICARE ADV]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_COMMUNICARE ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_COMMUNICARE ADV]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_COMMUNICARE ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_COMPSYCH]|[plan_COMMERCIAL] standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_COMPSYCH]|[plan_COMMERCIAL] standard_charge|[payer_FIRELANDS COUNSELING RECC]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_FIRELANDS COUNSELING RECC]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_FIRELANDS COUNSELING RECC]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_FIRELANDS COUNSELING RECC]|[plan_LOCAL GOVT] standard_charge|[payer_FIRELANDS COUNSELING RECC]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_FIRELANDS COUNSELING RECC]|[plan_LOCAL GOVT] standard_charge|[payer_FRONTPATH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_FRONTPATH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_FRONTPATH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_FRONTPATH]|[plan_COMMERCIAL] standard_charge|[payer_FRONTPATH]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_FRONTPATH]|[plan_COMMERCIAL] standard_charge|[payer_GAINWELL TECHNOLOGIES]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_GAINWELL TECHNOLOGIES]|[plan_MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_GAINWELL TECHNOLOGIES]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_GAINWELL TECHNOLOGIES]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_GAINWELL TECHNOLOGIES]|[plan_MEDICAID: OUT OF STATE]|methodology additional_payer_notes |[payer_GAINWELL TECHNOLOGIES]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_GEHA]|[plan_COMMERCIAL] standard_charge|[payer_GEHA]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_GEHA]|[plan_COMMERCIAL] standard_charge|[payer_HEALTHSCOPE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHSCOPE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTHSCOPE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTHSCOPE]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_HEALTHSCOPE]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA GOLD CHOICE MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD CHOICE MCR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_HUMANA GOLD CHOICE MCR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_HUMANA GOLD CHOICE MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD CHOICE MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA GOLD CHOICE MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA HEALTHY HORIZONS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HUMANA HEALTHY HORIZONS]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_HUMANA HEALTHY HORIZONS]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_HUMANA HEALTHY HORIZONS]|[plan_MANAGED MEDICAID] standard_charge|[payer_HUMANA HEALTHY HORIZONS]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_HUMANA HEALTHY HORIZONS]|[plan_MANAGED MEDICAID] standard_charge|[payer_JP FARLEY CORPORATION]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_JP FARLEY CORPORATION]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_JP FARLEY CORPORATION]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_JP FARLEY CORPORATION]|[plan_COMMERCIAL] standard_charge|[payer_JP FARLEY CORPORATION]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_JP FARLEY CORPORATION]|[plan_COMMERCIAL] 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_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_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MAGELLAN]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MAGELLAN]|[plan_HMO/PPO] standard_charge|[payer_MEDBEN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MEDBEN]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MEDBEN]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MEDBEN]|[plan_HMO/PPO] standard_charge|[payer_MEDBEN]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MEDBEN]|[plan_HMO/PPO] standard_charge|[payer_MEDICAID]|[plan_MEDICAID ]|negotiated_dollar standard_charge|[payer_MEDICAID]|[plan_MEDICAID ]|negotiated_percentage standard_charge|[payer_MEDICAID]|[plan_MEDICAID ]|negotiated_algorithm estimated_amount|[payer_MEDICAID]|[plan_MEDICAID ] standard_charge|[payer_MEDICAID]|[plan_MEDICAID ]|methodology additional_payer_notes |[payer_MEDICAID]|[plan_MEDICAID ] standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO] standard_charge|[payer_MEDICAL MUTUAL]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MEDICAL MUTUAL]|[plan_HMO/PPO] standard_charge|[payer_MEDICAL MUTUAL MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICAL MUTUAL MCR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MEDICAL MUTUAL MCR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MEDICAL MUTUAL MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_MEDICAL MUTUAL MCR]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_MEDICAL MUTUAL MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDIGOLD MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MEDIGOLD MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MEDIGOLD MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MEDIGOLD MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MEDIGOLD MEDICARE]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_MEDIGOLD MEDICARE]|[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_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA HEALTHCARE OF OHIO]|[plan_MANAGED MEDICAID] 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_MOLINA MARKETPLACE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MOLINA MARKETPLACE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MOLINA MARKETPLACE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MOLINA MARKETPLACE]|[plan_HMO/PPO] standard_charge|[payer_MOLINA MARKETPLACE]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MOLINA MARKETPLACE]|[plan_HMO/PPO] standard_charge|[payer_MOLINA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MOLINA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MOLINA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payerMOLINA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MOLINA MEDICARE]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_MOLINA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MOLINA MYCARE MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MOLINA MYCARE MCR]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MOLINA MYCARE MCR]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MOLINA MYCARE MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_MOLINA MYCARE MCR]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_MOLINA MYCARE MCR]|[plan_MANAGED MEDICARE] 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_OHIO HEALTHY]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OHIO HEALTHY]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_OHIO HEALTHY]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_OHIO HEALTHY]|[plan_HMO/PPO] standard_charge|[payer_OHIO HEALTHY]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_OHIO HEALTHY]|[plan_HMO/PPO] standard_charge|[payer_OHIORISE - AETNA BETTER]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_OHIORISE - AETNA BETTER]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_OHIORISE - AETNA BETTER]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_OHIORISE - AETNA BETTER]|[plan_MANAGED MEDICAID] standard_charge|[payer_OHIORISE - AETNA BETTER]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_OHIORISE - AETNA BETTER]|[plan_MANAGED MEDICAID] standard_charge|[payer_OPTUM]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_OPTUM]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_OPTUM]|[plan_HMO/PPO] standard_charge|[payer_OPTUM]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_OPTUM]|[plan_HMO/PPO] standard_charge|[payer_OXFORD]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OXFORD]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_OXFORD]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_OXFORD]|[plan_HMO/PPO] standard_charge|[payer_OXFORD]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_OXFORD]|[plan_HMO/PPO] standard_charge|[payer_PARAMOUNT HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PARAMOUNT HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_PARAMOUNT HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_PARAMOUNT HEALTHCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_PARAMOUNT HEALTHCARE]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_PARAMOUNT HEALTHCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_PASSPORT HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PASSPORT HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_PASSPORT HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_PASSPORT HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_PASSPORT HEALTH PLAN]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_PASSPORT HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_STARK CO ADAMH]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_STARK CO ADAMH]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_STARK CO ADAMH]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_STARK CO ADAMH]|[plan_LOCAL GOVT] standard_charge|[payer_STARK CO ADAMH]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_STARK CO ADAMH]|[plan_LOCAL GOVT] standard_charge|[payer_SUMMACARE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_SUMMACARE]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_SUMMACARE]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_SUMMACARE]|[plan_COMMERCIAL] standard_charge|[payer_SUMMACARE]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_SUMMACARE]|[plan_COMMERCIAL] standard_charge|[payer_TCN BEHAVIORAL HEALTH]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TCN BEHAVIORAL HEALTH]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_TCN BEHAVIORAL HEALTH]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_TCN BEHAVIORAL HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_TCN BEHAVIORAL HEALTH]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_TCN BEHAVIORAL HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_THE COUNSELING CENTER]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_THE COUNSELING CENTER]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_THE COUNSELING CENTER]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_THE COUNSELING CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_THE COUNSELING CENTER]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_THE COUNSELING CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_THE HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_THE HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_THE HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_THE HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_THE HEALTH PLAN]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_THE HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_THE HEALTH PLAN MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_THE HEALTH PLAN MCD]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_THE HEALTH PLAN MCD]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_THE HEALTH PLAN MCD]|[plan_MANAGED MEDICAID]|[plan_HMO/PPO] standard_charge|[payer_THE HEALTH PLAN MCD]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_THE HEALTH PLAN MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_TRI COUNTY BOARD]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TRI COUNTY BOARD]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_TRI COUNTY BOARD]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_TRI COUNTY BOARD]|[plan_LOCAL GOVT] standard_charge|[payer_TRI COUNTY BOARD]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_TRI COUNTY BOARD]|[plan_LOCAL GOVT] standard_charge|[payer_TRICARE EAST REGION]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST REGION]|[plan_TRICARE]|negotiated_percentage standard_charge|[payer_TRICARE EAST REGION]|[plan_TRICARE]|negotiated_algorithm estimated_amount|[payer_TRICARE EAST REGION]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST REGION]|[plan_TRICARE]|methodology additional_payer_notes |[payer_TRICARE EAST REGION]|[plan_TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE]|[plan_COMMERCIAL] standard_charge|[payer_TRICARE FOR LIFE]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_TRICARE FOR LIFE]|[plan_COMMERCIAL] standard_charge|[payer_TRUSTMARK HEALTH BENEFITS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TRUSTMARK HEALTH BENEFITS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_TRUSTMARK HEALTH BENEFITS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_TRUSTMARK HEALTH BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_TRUSTMARK HEALTH BENEFITS]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_TRUSTMARK HEALTH BENEFITS]|[plan_HMO/PPO] standard_charge|[payer_UBH MCR ADV]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UBH MCR ADV]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_UBH MCR ADV]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_UBH MCR ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_UBH MCR ADV]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_UBH MCR ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC CHOICE PLUS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHC CHOICE PLUS]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UHC CHOICE PLUS]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UHC CHOICE PLUS]|[plan_HMO/PPO] standard_charge|[payer_UHC CHOICE PLUS]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UHC CHOICE PLUS]|[plan_HMO/PPO] standard_charge|[payer_UHC COMMUNITY HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY HEALTH]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_UHC COMMUNITY HEALTH]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY HEALTH]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_UHC COMMUNITY HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY HEALTH MCD]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY HEALTH MCD]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UHC COMMUNITY HEALTH MCD]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY HEALTH MCD]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY HEALTH MCD]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_UHC COMMUNITY HEALTH MCD]|[plan_MANAGED MEDICAID] 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_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_UNICARE HEALTH PLAN OF WV]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UNICARE HEALTH PLAN OF WV]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UNICARE HEALTH PLAN OF WV]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UNICARE HEALTH PLAN OF WV]|[plan_MANAGED MEDICAID] standard_charge|[payer_UNICARE HEALTH PLAN OF WV]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_UNICARE HEALTH PLAN OF WV]|[plan_MANAGED MEDICAID] 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_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_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] standard_charge|[payer_X COMMERCIAL-ENTER NAME]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_X COMMERCIAL-ENTER NAME]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_X COMMERCIAL-ENTER NAME]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_X COMMERCIAL-ENTER NAME]|[plan_COMMERCIAL] standard_charge|[payer_X COMMERCIAL-ENTER NAME]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_X COMMERCIAL-ENTER NAME]|[plan_COMMERCIAL] standard_charge|[payer_X WORK COMP-ENTER NAME]|[plan_WORKERS COMP]|negotiated_dollar standard_charge|[payer_X WORK COMP-ENTER NAME]|[plan_WORKERS COMP]|negotiated_percentage standard_charge|[payer_X WORK COMP-ENTER NAME]|[plan_WORKERS COMP]|negotiated_algorithm estimated_amount|[payer_X WORK COMP-ENTER NAME]|[plan_WORKERS COMP] standard_charge|[payer_X WORK COMP-ENTER NAME]|[plan_WORKERS COMP] |methodology additional_payer_notes |[payer_X WORK COMP-ENTER NAME]|[plan_WORKERS COMP] standard_charge|min standard_charge | max additional_generic_notes ADULT ROOM AND BOARD 124 RC inpatient 4400 750 4400 per diem 827 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 1661 per diem 1503.73 per diem 4400 per diem 827 per diem 759 per diem 800 per diem 954 per diem 800 per diem 850 per diem 4400 per diem 824 per diem 824 per diem 767 per diem 800 per diem 660 per diem 743 per diem 651 per diem 1986 per diem 800 per diem 4400 per diem 632.31 per diem 4400 per diem 4400 per diem 4400 per diem 827 per diem 1200 per diem 4400 per diem 4400 per diem 4400 per diem 844 per diem 1100 per diem 925 per diem 759 per diem 4400 per diem 1100 per diem 827 per diem 827 per diem 800 per diem 4400 per diem 800 per diem 4400 per diem 800 per diem 800 per diem 4400 per diem 560 per diem 900 per diem 831 per diem 831 per diem 1100 per diem 838 per diem 827 per diem 827 per diem 827 per diem 827 per diem 1080 per diem 827 per diem 900 per diem 4400 per diem 4400 per diem 560 4400 ADULT ROOM AND BOARD DETOX 126 RC inpatient 4400 660 per diem 660 660 DETOX ROOM AND BOARD 126 RC inpatient 4400 660 per diem 660 660 INTENSIVE OUTPATIENT PROGRAM ADULT PSYCH 905 RC outpatient 1000 201.34 170 per diem 150 per diem 200 per diem 157 per diem 182.66 per diem 157 per diem 150 per diem 206 per diem 170 per diem 159 per diem 150 per diem 142 per diem 192 per diem 226.56 per diem 170 per diem 182.66 per diem 182.66 per diem 170 per diem 150 per diem 155 per diem 150 per diem 182.66 per diem 150 per diem 150 per diem 142 226.56 TBS MCD ADULT PSYCH 907 RC outpatient 600 300 250 per diem 323 per diem 146.27 per diem 135.92 per diem 182.66 per diem 180 per diem 135.92 per diem 135.92 per diem 182.66 per diem 135.92 323 CRISIS PSYCHOTHERAPY 910 RC outpatient 112.27 73.06 per diem 73.06 per diem 58.27 per diem 73.06 per diem 73.06 per diem 73.06 per diem 73.06 per diem 73.06 per diem 58.27 73.06 INIT PSYCH EVL 90791 910 RC outpatient 130.72 73.06 per diem 73.06 per diem 73.06 per diem 58.27 per diem 73.06 per diem 73.06 per diem 73.06 per diem 73.06 per diem 73.06 per diem 58.27 73.06 INIT PSYCH EVL 90792 910 RC outpatient 144.35 73.06 per diem 73.06 per diem 73.06 per diem 58.27 per diem 73.06 per diem 73.06 per diem 73.06 per diem 73.06 per diem 73.06 per diem 58.27 73.06 GROUP PSYCHOTHERAPY 915 RC outpatient 90 331 per diem 73.06 per diem 226.56 per diem 331 per diem 206.71 per diem 433.27 per diem 206.71 per diem 36.53 per diem 206.71 per diem 433.27 per diem 36.53 per diem 433.27 per diem 433.27 per diem 36.53 per diem 206.71 per diem 36.53 per diem 421.82 per diem 226.56 per diem 36.53 per diem 36.53 per diem 383 per diem 433.27 per diem 36.53 per diem 36.53 433.27 INTENSIVE OUTPATIENT PROGRAM PROC GRP 1 MCD 915 RC outpatient 200 331 per diem 36.53 per diem 226.56 per diem 331 per diem 206.71 per diem 433.27 per diem 206.71 per diem 36.53 per diem 206.71 per diem 433.27 per diem 36.53 per diem 433.27 per diem 433.27 per diem 36.53 per diem 206.71 per diem 36.53 per diem 421.82 per diem 226.56 per diem 36.53 per diem 36.53 per diem 383 per diem 433.27 per diem 36.53 per diem 36.53 433.27 INTENSIVE OUTPATIENT PROGRAM PROC GRP 1 MCR 915 RC outpatient 283.33 331 per diem 36.53 per diem 226.56 per diem 331 per diem 206.71 per diem 433.27 per diem 206.71 per diem 36.53 per diem 206.71 per diem 433.27 per diem 36.53 per diem 433.27 per diem 433.27 per diem 36.53 per diem 206.71 per diem 36.53 per diem 421.82 per diem 226.56 per diem 36.53 per diem 36.53 per diem 383 per diem 433.27 per diem 36.53 per diem 36.53 433.27 INTENSIVE OUTPATIENT PROGRAM PROC GRP 2 MCD 915 RC outpatient 100 331 per diem 36.53 per diem 226.56 per diem 331 per diem 206.71 per diem 433.27 per diem 206.71 per diem 36.53 per diem 206.71 per diem 433.27 per diem 36.53 per diem 433.27 per diem 433.27 per diem 36.53 per diem 206.71 per diem 36.53 per diem 421.82 per diem 226.56 per diem 36.53 per diem 36.53 per diem 383 per diem 433.27 per diem 36.53 per diem 36.53 433.27 PHYSICIAN BILLING 90791 RC both 310 36.53 per diem 99.63 fee schedule 99.63 99.63 PHYSICIAN BILLING 90792 RC both 310 133.53 fee schedule 86.17 fee schedule 73.79 fee schedule 19.47 fee schedule 86.58 fee schedule 78.32 fee schedule 74.83 fee schedule 101.81 fee schedule 92.44 fee schedule 141.87 fee schedule 83.14 fee schedule 83.14 fee schedule 31.46 fee schedule 47.42 fee schedule 95 fee schedule 95 fee schedule 100.24 fee schedule 170.32 fee schedule 19.47 170.32 PHYSICIAN BILLING 99221 RC both 125 37.61 fee schedule 34.59 fee schedule 31.97 fee schedule 72.39 fee schedule 22.57 fee schedule 33.85 fee schedule 54.52 fee schedule 37.61 fee schedule 37.61 fee schedule 22.57 72.39 PHYSICIAN BILLING 99222 RC both 125 106.51 fee schedule 106.51 106.51 PHYSICIAN BILLING 99231 RC both 120 31.4 fee schedule 17.49 fee schedule 16.65 fee schedule 15.39 fee schedule 9.98 fee schedule 23.28 fee schedule 15.9 fee schedule 32.59 fee schedule 24.53 fee schedule 15.74 fee schedule 27.7 fee schedule 29.77 fee schedule 17.49 fee schedule 51.15 fee schedule 35.58 fee schedule 17.49 fee schedule 66.83 fee schedule 40.75 fee schedule 100.24 fee schedule 34.25 fee schedule 28.9 fee schedule 45.58 fee schedule 9.98 100.24 PHYSICIAN BILLING 99232 RC both 140 28.18 fee schedule 47.16 fee schedule 26.07 fee schedule 51.76 fee schedule 27.96 fee schedule 51.76 fee schedule 25.36 fee schedule 47.18 fee schedule 28.18 fee schedule 21 fee schedule 64.7 fee schedule 28.18 fee schedule 64.7 fee schedule 44.75 fee schedule 68.93 fee schedule 21 68.93 PHYSICIAN BILLING 99238 RC both 160 31.62 fee schedule 10.17 fee schedule 27.67 fee schedule 52.59 fee schedule 28.51 fee schedule 45.19 fee schedule 28.46 fee schedule 42.93 fee schedule 52.59 fee schedule 31.62 fee schedule 24.78 fee schedule 65.73 fee schedule 31.62 fee schedule 27.54 fee schedule 46.03 fee schedule 59.85 fee schedule 46.03 fee schedule 71.8 fee schedule 10.17 71.8