hospital_name last_updated_on version hospital_location hospital_address license_number|AZ "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." Sonora Behaviroal Health 5/31/2024 2.0.0 "Tucson, Arizona" 6050 North Corona Road license_SH4089 |AZ TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AARP MEDICARE SUPPLEMENT]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_AARP MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AARP MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AARP MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] standard_charge|[payer_AARP MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_AARP MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] 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_AHCCCS FEDERAL EMERG]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_AHCCCS FEDERAL EMERG]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_AHCCCS FEDERAL EMERG]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_AHCCCS FEDERAL EMERG]|[plan_MEDICAID ] standard_charge|[payer_AHCCCS FEDERAL EMERG]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_AHCCCS FEDERAL EMERG]|[plan_MEDICAID ] standard_charge|[payer_AHCCCS FFS]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_AHCCCS FFS]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_AHCCCS FFS]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_AHCCCS FFS]|[plan_MEDICAID ] standard_charge|[payer_AHCCCS FFS]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_AHCCCS FFS]|[plan_MEDICAID ] standard_charge|[payer_AHCCCS IHS]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_AHCCCS IHS]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_AHCCCS IHS]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_AHCCCS IHS]|[plan_MEDICAID ] standard_charge|[payer_AHCCCS IHS]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_AHCCCS IHS]|[plan_MEDICAID ] standard_charge|[payer_AHCCCS PENDING]|[plan_PENDING MEDICAID]| negotiated_dollar standard_charge|[payer_AHCCCS PENDING]|[plan_PENDING MEDICAID] |negotiated_percentage standard_charge|[payer_AHCCCS PENDING]|[plan_PENDING MEDICAID] |negotiated_algorithm estimated_amount|[payer_AHCCCS PENDING]|[plan_PENDING MEDICAID] standard_charge|[payer_AHCCCS PENDING]|[plan_PENDING MEDICAID] |methodology additional_payer_notes|[payer_AHCCCS PENDING]|[plan_PENDING MEDICAID] standard_charge|[payer_ALLEGIANCE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_ALLEGIANCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLEGIANCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLEGIANCE]|[plan_COMMERCIAL] standard_charge|[payer_ALLEGIANCE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_ALLEGIANCE]|[plan_COMMERCIAL] standard_charge|[payer_ALLIANCE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_ALLIANCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLIANCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLIANCE]|[plan_COMMERCIAL] standard_charge|[payer_ALLIANCE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_ALLIANCE]|[plan_COMMERCIAL] standard_charge|[payer_ALLIED BENEFITS]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_ALLIED BENEFITS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLIED BENEFITS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLIED BENEFITS]|[plan_COMMERCIAL] standard_charge|[payer_ALLIED BENEFITS]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_ALLIED BENEFITS]|[plan_COMMERCIAL] standard_charge|[payer_ALLWELL FROM AZ COMP]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_ALLWELL FROM AZ COMP]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALLWELL FROM AZ COMP]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALLWELL FROM AZ COMP]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL FROM AZ COMP]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_ALLWELL FROM AZ COMP]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALORICA]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_ALORICA]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALORICA]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALORICA]|[plan_COMMERCIAL] standard_charge|[payer_ALORICA]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_ALORICA]|[plan_COMMERCIAL] 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_ARGUS]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_ARGUS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ARGUS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ARGUS]|[plan_COMMERCIAL] standard_charge|[payer_ARGUS]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_ARGUS]|[plan_COMMERCIAL] standard_charge|[payer_ARIZ FOUNDATION]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_ARIZ FOUNDATION]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ARIZ FOUNDATION]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ARIZ FOUNDATION]|[plan_HMO/PPO] standard_charge|[payer_ARIZ FOUNDATION]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_ARIZ FOUNDATION]|[plan_HMO/PPO] standard_charge|[payer_AZ COMPLETE HEALTH]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_AZ COMPLETE HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AZ COMPLETE HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AZ COMPLETE HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_AZ COMPLETE HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_AZ COMPLETE HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_BANNER UNIV CARE ADVANTAG]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_BANNER UNIV CARE ADVANTAG]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BANNER UNIV CARE ADVANTAG]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BANNER UNIV CARE ADVANTAG]|[plan_MANAGED MEDICARE] standard_charge|[payer_BANNER UNIV CARE ADVANTAG]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_BANNER UNIV CARE ADVANTAG]|[plan_MANAGED MEDICARE] standard_charge|[payer_BANNER UNIV FAMILY CARE]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_BANNER UNIV FAMILY CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BANNER UNIV FAMILY CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BANNER UNIV FAMILY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_BANNER UNIV FAMILY CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_BANNER UNIV FAMILY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_BCBS ARIZONA]|[plan_BLUE CROSS]| negotiated_dollar standard_charge|[payer_BCBS ARIZONA]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS ARIZONA]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS ARIZONA]|[plan_BLUE CROSS] standard_charge|[payer_BCBS ARIZONA]|[plan_BLUE CROSS] |methodology additional_payer_notes|[payer_BCBS ARIZONA]|[plan_BLUE CROSS] standard_charge|[payer_BCBS CORP HEALTH]|[plan_BLUE CROSS]| negotiated_dollar standard_charge|[payer_BCBS CORP HEALTH]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS CORP HEALTH]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS CORP HEALTH]|[plan_BLUE CROSS] standard_charge|[payer_BCBS CORP HEALTH]|[plan_BLUE CROSS] |methodology additional_payer_notes|[payer_BCBS CORP HEALTH]|[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 MDCR ADVANTAGE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_BCBS MDCR ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BCBS MDCR ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BCBS MDCR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS MDCR ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_BCBS MDCR ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BCBS OF NEW MEXICO MCD]|[plan_MEDICAID: OUT OF STATE]| negotiated_dollar standard_charge|[payer_BCBS OF NEW MEXICO MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_BCBS OF NEW MEXICO MCD]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_BCBS OF NEW MEXICO MCD]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_BCBS OF NEW MEXICO MCD]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes|[payer_BCBS OF NEW MEXICO MCD]|[plan_MEDICAID: OUT OF STATE] 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_BOON GROUP]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_BOON GROUP]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BOON GROUP]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BOON GROUP]|[plan_COMMERCIAL] standard_charge|[payer_BOON GROUP]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_BOON GROUP]|[plan_COMMERCIAL] standard_charge|[payer_BRIGHT HEALTH]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_BRIGHT HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BRIGHT HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BRIGHT HEALTH]|[plan_HMO/PPO] standard_charge|[payer_BRIGHT HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_BRIGHT HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CARE 1ST HEALTH PLAN]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_CARE 1ST HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CARE 1ST HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CARE 1ST HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_CARE 1ST HEALTH PLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_CARE 1ST HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_CAREMORE MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_CAREMORE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CAREMORE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CAREMORE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CAREMORE MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_CAREMORE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CARESOURCE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_CARESOURCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CARESOURCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CARESOURCE]|[plan_COMMERCIAL] standard_charge|[payer_CARESOURCE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_CARESOURCE]|[plan_COMMERCIAL] standard_charge|[payer_CENTURY HEALTHCARE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_CENTURY HEALTHCARE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CENTURY HEALTHCARE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CENTURY HEALTHCARE]|[plan_COMMERCIAL] standard_charge|[payer_CENTURY HEALTHCARE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_CENTURY HEALTHCARE]|[plan_COMMERCIAL] standard_charge|[payer_CHAMP VA]|[plan_VETERANS ADMIN]| negotiated_dollar standard_charge|[payer_CHAMP VA]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMP VA]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMP VA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMP VA]|[plan_VETERANS ADMIN] |methodology additional_payer_notes|[payer_CHAMP VA]|[plan_VETERANS ADMIN] standard_charge|[payer_CIGNA]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_CIGNA]|[plan_HMO/PPO] standard_charge|[payer_CIGNA]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_CIGNA]|[plan_HMO/PPO] standard_charge|[payer_CIGNA MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_CIGNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_CIGNA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_CLOVER HEALTH CHOICE MC]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_CLOVER HEALTH CHOICE MC]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CLOVER HEALTH CHOICE MC]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CLOVER HEALTH CHOICE MC]|[plan_MANAGED MEDICARE] standard_charge|[payer_CLOVER HEALTH CHOICE MC]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_CLOVER HEALTH CHOICE MC]|[plan_MANAGED MEDICARE] standard_charge|[payer_CMDP]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_CMDP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CMDP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CMDP]|[plan_MANAGED MEDICAID] standard_charge|[payer_CMDP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_CMDP]|[plan_MANAGED MEDICAID] standard_charge|[payer_COCHISE COUNTY TITLE 36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_COCHISE COUNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_COCHISE COUNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_COCHISE COUNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_COCHISE COUNTY TITLE 36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_COCHISE COUNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_COFINITY]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_COFINITY]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_COFINITY]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_COFINITY]|[plan_COMMERCIAL] standard_charge|[payer_COFINITY]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_COFINITY]|[plan_COMMERCIAL] standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] standard_charge|[payer_COMP PSYCH]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_COMP PSYCH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_COMP PSYCH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_COMP PSYCH]|[plan_COMMERCIAL] standard_charge|[payer_COMP PSYCH]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_COMP PSYCH]|[plan_COMMERCIAL] standard_charge|[payer_CONDUENT STATE HEALTHCARE]|[plan_MEDICAID: OUT OF STATE]| negotiated_dollar standard_charge|[payer_CONDUENT STATE HEALTHCARE]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_CONDUENT STATE HEALTHCARE]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_CONDUENT STATE HEALTHCARE]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_CONDUENT STATE HEALTHCARE]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes|[payer_CONDUENT STATE HEALTHCARE]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_CONNECTICARE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_CONNECTICARE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CONNECTICARE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CONNECTICARE]|[plan_COMMERCIAL] standard_charge|[payer_CONNECTICARE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_CONNECTICARE]|[plan_COMMERCIAL] standard_charge|[payer_CONSOLIDATED HEALTH PLAN]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_CONSOLIDATED HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CONSOLIDATED HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CONSOLIDATED HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_CONSOLIDATED HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_CONSOLIDATED HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_CONTINENTAL BENEFITS]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_CONTINENTAL BENEFITS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CONTINENTAL BENEFITS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CONTINENTAL BENEFITS]|[plan_COMMERCIAL] standard_charge|[payer_CONTINENTAL BENEFITS]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_CONTINENTAL BENEFITS]|[plan_COMMERCIAL] standard_charge|[payer_DCS ACYF]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_DCS ACYF]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_DCS ACYF]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_DCS ACYF]|[plan_LOCAL GOVT] standard_charge|[payer_DCS ACYF]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_DCS ACYF]|[plan_LOCAL GOVT] standard_charge|[payer_DCS CHP MERCY CARE]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_DCS CHP MERCY CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_DCS CHP MERCY CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_DCS CHP MERCY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_DCS CHP MERCY CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_DCS CHP MERCY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_DEAN HEALTH PLAN]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_DEAN HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_DEAN HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_DEAN HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_DEAN HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_DEAN HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_EBMS]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_EBMS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_EBMS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_EBMS]|[plan_COMMERCIAL] standard_charge|[payer_EBMS]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_EBMS]|[plan_COMMERCIAL] standard_charge|[payer_FIRST HEALTH]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_FIRST HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_FIRST HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_FIRST HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_FIRST HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_FIRST HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_FIRST HEALTH]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_FIRST HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_FIRST HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FIRST HEALTH]|[plan_HMO/PPO] standard_charge|[payer_FIRST HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_FIRST HEALTH]|[plan_HMO/PPO] standard_charge|[payer_FT DEFIANCE]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_FT DEFIANCE]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_FT DEFIANCE]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_FT DEFIANCE]|[plan_LOCAL GOVT] standard_charge|[payer_FT DEFIANCE]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_FT DEFIANCE]|[plan_LOCAL GOVT] standard_charge|[payer_GEHA ASA]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_GEHA ASA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GEHA ASA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GEHA ASA]|[plan_HMO/PPO] standard_charge|[payer_GEHA ASA]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_GEHA ASA]|[plan_HMO/PPO] standard_charge|[payer_GEHA FEHB]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_GEHA FEHB]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GEHA FEHB]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GEHA FEHB]|[plan_HMO/PPO] standard_charge|[payer_GEHA FEHB]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_GEHA FEHB]|[plan_HMO/PPO] standard_charge|[payer_GILA COUNTY FINANCE DEPT]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_GILA COUNTY FINANCE DEPT]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_GILA COUNTY FINANCE DEPT]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_GILA COUNTY FINANCE DEPT]|[plan_LOCAL GOVT] standard_charge|[payer_GILA COUNTY FINANCE DEPT]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_GILA COUNTY FINANCE DEPT]|[plan_LOCAL GOVT] standard_charge|[payer_GILA RIVER IHS HEALTHCARE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_GILA RIVER IHS HEALTHCARE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GILA RIVER IHS HEALTHCARE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GILA RIVER IHS HEALTHCARE]|[plan_COMMERCIAL] standard_charge|[payer_GILA RIVER IHS HEALTHCARE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_GILA RIVER IHS HEALTHCARE]|[plan_COMMERCIAL] standard_charge|[payer_GILA RIVER T36 TRIBE]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_GILA RIVER T36 TRIBE]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_GILA RIVER T36 TRIBE]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_GILA RIVER T36 TRIBE]|[plan_LOCAL GOVT] standard_charge|[payer_GILA RIVER T36 TRIBE]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_GILA RIVER T36 TRIBE]|[plan_LOCAL GOVT] standard_charge|[payer_GOLDEN RULE UHC]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_GOLDEN RULE UHC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GOLDEN RULE UHC]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GOLDEN RULE UHC]|[plan_HMO/PPO] standard_charge|[payer_GOLDEN RULE UHC]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_GOLDEN RULE UHC]|[plan_HMO/PPO] standard_charge|[payer_GRAHAM CNTY TITLE 36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_GRAHAM CNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_GRAHAM CNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_GRAHAM CNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_GRAHAM CNTY TITLE 36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_GRAHAM CNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_GREAT WEST]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_GREAT WEST]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GREAT WEST]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GREAT WEST]|[plan_COMMERCIAL] standard_charge|[payer_GREAT WEST]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_GREAT WEST]|[plan_COMMERCIAL] standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GREAT WEST]|[plan_HMO/PPO] standard_charge|[payer_GREAT WEST]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_GREAT WEST]|[plan_HMO/PPO] standard_charge|[payer_GREENLEE COUNTY T36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_GREENLEE COUNTY T36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_GREENLEE COUNTY T36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_GREENLEE COUNTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_GREENLEE COUNTY T36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_GREENLEE COUNTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_GROUP PENSION ADMIN]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_GROUP PENSION ADMIN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GROUP PENSION ADMIN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GROUP PENSION ADMIN]|[plan_COMMERCIAL] standard_charge|[payer_GROUP PENSION ADMIN]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_GROUP PENSION ADMIN]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH COMP]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_HEALTH COMP]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTH COMP]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTH COMP]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH COMP]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_HEALTH COMP]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH FIRST]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_HEALTH FIRST]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTH FIRST]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTH FIRST]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH FIRST]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_HEALTH FIRST]|[plan_COMMERCIAL] standard_charge|[payer_HEALTHCHOICE AZ]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_HEALTHCHOICE AZ]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_HEALTHCHOICE AZ]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_HEALTHCHOICE AZ]|[plan_MANAGED MEDICAID] standard_charge|[payer_HEALTHCHOICE AZ]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_HEALTHCHOICE AZ]|[plan_MANAGED MEDICAID] standard_charge|[payer_HEALTHCHOICE MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_HEALTHCHOICE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HEALTHCHOICE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HEALTHCHOICE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HEALTHCHOICE MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_HEALTHCHOICE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HELMSMAN MANAGEMENT SERVI]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_HELMSMAN MANAGEMENT SERVI]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HELMSMAN MANAGEMENT SERVI]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HELMSMAN MANAGEMENT SERVI]|[plan_COMMERCIAL] standard_charge|[payer_HELMSMAN MANAGEMENT SERVI]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_HELMSMAN MANAGEMENT SERVI]|[plan_COMMERCIAL] standard_charge|[payer_HMA NAVAJO NATION EMP]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_HMA NAVAJO NATION EMP]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_HMA NAVAJO NATION EMP]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_HMA NAVAJO NATION EMP]|[plan_LOCAL GOVT] standard_charge|[payer_HMA NAVAJO NATION EMP]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_HMA NAVAJO NATION EMP]|[plan_LOCAL GOVT] standard_charge|[payer_HMC HEALTH WORKS]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_HMC HEALTH WORKS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HMC HEALTH WORKS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HMC HEALTH WORKS]|[plan_HMO/PPO] standard_charge|[payer_HMC HEALTH WORKS]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_HMC HEALTH WORKS]|[plan_HMO/PPO] standard_charge|[payer_HOLMAN GROUP]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_HOLMAN GROUP]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HOLMAN GROUP]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HOLMAN GROUP]|[plan_HMO/PPO] standard_charge|[payer_HOLMAN GROUP]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_HOLMAN GROUP]|[plan_HMO/PPO] standard_charge|[payer_HOPI HEALTH CARE CENTER]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_HOPI HEALTH CARE CENTER]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_HOPI HEALTH CARE CENTER]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_HOPI HEALTH CARE CENTER]|[plan_LOCAL GOVT] standard_charge|[payer_HOPI HEALTH CARE CENTER]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_HOPI HEALTH CARE CENTER]|[plan_LOCAL GOVT] 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] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA GOLD MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_HUMANA GOLD MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_ICE]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_ICE]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ICE]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_ICE]|[plan_LOCAL GOVT] standard_charge|[payer_ICE]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_ICE]|[plan_LOCAL GOVT] standard_charge|[payer_IEHP HEALTH ACCESS]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_IEHP HEALTH ACCESS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_IEHP HEALTH ACCESS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_IEHP HEALTH ACCESS]|[plan_MANAGED MEDICARE] standard_charge|[payer_IEHP HEALTH ACCESS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_IEHP HEALTH ACCESS]|[plan_MANAGED MEDICARE] standard_charge|[payer_IHS CONTRACT SERVICES]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_IHS CONTRACT SERVICES]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_IHS CONTRACT SERVICES]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_IHS CONTRACT SERVICES]|[plan_LOCAL GOVT] standard_charge|[payer_IHS CONTRACT SERVICES]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_IHS CONTRACT SERVICES]|[plan_LOCAL GOVT] standard_charge|[payer_IHS TOHONO OODHAM NATION]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_IHS TOHONO OODHAM NATION]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_IHS TOHONO OODHAM NATION]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_IHS TOHONO OODHAM NATION]|[plan_COMMERCIAL] standard_charge|[payer_IHS TOHONO OODHAM NATION]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_IHS TOHONO OODHAM NATION]|[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_LIFE SHIELD STM]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_LIFE SHIELD STM]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_LIFE SHIELD STM]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_LIFE SHIELD STM]|[plan_COMMERCIAL] standard_charge|[payer_LIFE SHIELD STM]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_LIFE SHIELD STM]|[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_MARICOPA CTY T36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_MARICOPA CTY T36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MARICOPA CTY T36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_MARICOPA CTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_MARICOPA CTY T36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_MARICOPA CTY T36]|[plan_LOCAL GOVT] 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_MERCY CARE MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_MERCY CARE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MERCY CARE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MERCY CARE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MERCY CARE MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_MERCY CARE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MERCY CARE PLAN]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_MERCY CARE PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MERCY CARE PLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MERCY CARE PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_MERCY CARE PLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_MERCY CARE PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_MERCY MARICOPA RBHA]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_MERCY MARICOPA RBHA]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MERCY MARICOPA RBHA]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MERCY MARICOPA RBHA]|[plan_MANAGED MEDICAID] standard_charge|[payer_MERCY MARICOPA RBHA]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_MERCY MARICOPA RBHA]|[plan_MANAGED MEDICAID] standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MERITAIN]|[plan_COMMERCIAL] standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_MERITAIN]|[plan_COMMERCIAL] standard_charge|[payer_MERITAIN]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_MERITAIN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MERITAIN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MERITAIN]|[plan_HMO/PPO] standard_charge|[payer_MERITAIN]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_MERITAIN]|[plan_HMO/PPO] standard_charge|[payer_MHN MANAGED HEALTH NETWOR]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_MHN MANAGED HEALTH NETWOR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MHN MANAGED HEALTH NETWOR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MHN MANAGED HEALTH NETWOR]|[plan_HMO/PPO] standard_charge|[payer_MHN MANAGED HEALTH NETWOR]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_MHN MANAGED HEALTH NETWOR]|[plan_HMO/PPO] standard_charge|[payer_MHN MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_MHN MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MHN MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MHN MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MHN MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_MHN MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MINES AND ASSOCIATES]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_MINES AND ASSOCIATES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MINES AND ASSOCIATES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MINES AND ASSOCIATES]|[plan_HMO/PPO] standard_charge|[payer_MINES AND ASSOCIATES]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_MINES AND ASSOCIATES]|[plan_HMO/PPO] standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC INSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_MISC INSURANCE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_MISC INSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_MOLINA COMPLETE CARE]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_MOLINA COMPLETE CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA COMPLETE CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA COMPLETE CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA COMPLETE CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_MOLINA COMPLETE CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF NM]|[plan_MEDICAID: OUT OF STATE]| negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OF NM]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OF NM]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OF NM]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MOLINA HEALTHCARE OF NM]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes|[payer_MOLINA HEALTHCARE OF NM]|[plan_MEDICAID: OUT OF STATE] 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_NAVAJO NATION T36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_NAVAJO NATION T36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_NAVAJO NATION T36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_NAVAJO NATION T36]|[plan_LOCAL GOVT] standard_charge|[payer_NAVAJO NATION T36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_NAVAJO NATION T36]|[plan_LOCAL GOVT] standard_charge|[payer_ONECARE MEDICARE ADVANT]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_ONECARE MEDICARE ADVANT]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ONECARE MEDICARE ADVANT]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ONECARE MEDICARE ADVANT]|[plan_MANAGED MEDICARE] standard_charge|[payer_ONECARE MEDICARE ADVANT]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_ONECARE MEDICARE ADVANT]|[plan_MANAGED MEDICARE] 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_P3 AZ HEALTH PARTNERS]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_P3 AZ HEALTH PARTNERS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_P3 AZ HEALTH PARTNERS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_P3 AZ HEALTH PARTNERS]|[plan_MANAGED MEDICARE] standard_charge|[payer_P3 AZ HEALTH PARTNERS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_P3 AZ HEALTH PARTNERS]|[plan_MANAGED MEDICARE] standard_charge|[payer_PACIFICSOURCE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_PACIFICSOURCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PACIFICSOURCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PACIFICSOURCE]|[plan_COMMERCIAL] standard_charge|[payer_PACIFICSOURCE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_PACIFICSOURCE]|[plan_COMMERCIAL] standard_charge|[payer_PIMA COUNTY T36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_PIMA COUNTY T36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_PIMA COUNTY T36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_PIMA COUNTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_PIMA COUNTY T36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_PIMA COUNTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_PINAL CNTY TITLE 36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_PINAL CNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_PINAL CNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_PINAL CNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_PINAL CNTY TITLE 36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_PINAL CNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_POINT COMFORT UNDERWRITER]|[plan_COMMERCIAL] standard_charge|[payer_PREFERRED ONE]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_PREFERRED ONE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PREFERRED ONE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PREFERRED ONE]|[plan_COMMERCIAL] standard_charge|[payer_PREFERRED ONE]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_PREFERRED ONE]|[plan_COMMERCIAL] standard_charge|[payer_PRESBYTERIAN CENTENNIAL]|[plan_MEDICAID: OUT OF STATE]| negotiated_dollar standard_charge|[payer_PRESBYTERIAN CENTENNIAL]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_PRESBYTERIAN CENTENNIAL]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_PRESBYTERIAN CENTENNIAL]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_PRESBYTERIAN CENTENNIAL]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes|[payer_PRESBYTERIAN CENTENNIAL]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_PROVIDENCE HEALTH PLAN]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_PROVIDENCE HEALTH PLAN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_PROVIDENCE HEALTH PLAN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PROVIDENCE HEALTH PLAN]|[plan_HMO/PPO] standard_charge|[payer_PROVIDENCE HEALTH PLAN]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_PROVIDENCE HEALTH PLAN]|[plan_HMO/PPO] standard_charge|[payer_SAN CARLOS APACHE HEALTH]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_SAN CARLOS APACHE HEALTH]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_SAN CARLOS APACHE HEALTH]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_SAN CARLOS APACHE HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_SAN CARLOS APACHE HEALTH]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_SAN CARLOS APACHE HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_SANTA CRUZ CTY T36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_SANTA CRUZ CTY T36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_SANTA CRUZ CTY T36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_SANTA CRUZ CTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_SANTA CRUZ CTY T36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_SANTA CRUZ CTY T36]|[plan_LOCAL GOVT] standard_charge|[payer_SAVAHCS]|[plan_VETERANS ADMIN]| negotiated_dollar standard_charge|[payer_SAVAHCS]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_SAVAHCS]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_SAVAHCS]|[plan_VETERANS ADMIN] standard_charge|[payer_SAVAHCS]|[plan_VETERANS ADMIN] |methodology additional_payer_notes|[payer_SAVAHCS]|[plan_VETERANS ADMIN] standard_charge|[payer_SUMMIT]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_SUMMIT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_SUMMIT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_SUMMIT]|[plan_COMMERCIAL] standard_charge|[payer_SUMMIT]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_SUMMIT]|[plan_COMMERCIAL] standard_charge|[payer_TRBHA APACHE SAN CARLOS]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA APACHE SAN CARLOS]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA APACHE SAN CARLOS]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA APACHE SAN CARLOS]|[plan_MEDICAID ] standard_charge|[payer_TRBHA APACHE SAN CARLOS]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA APACHE SAN CARLOS]|[plan_MEDICAID ] standard_charge|[payer_TRBHA APACHE WHITE MTN]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA APACHE WHITE MTN]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA APACHE WHITE MTN]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA APACHE WHITE MTN]|[plan_MEDICAID ] standard_charge|[payer_TRBHA APACHE WHITE MTN]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA APACHE WHITE MTN]|[plan_MEDICAID ] standard_charge|[payer_TRBHA GILA RIVER]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA GILA RIVER]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA GILA RIVER]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA GILA RIVER]|[plan_MEDICAID ] standard_charge|[payer_TRBHA GILA RIVER]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA GILA RIVER]|[plan_MEDICAID ] standard_charge|[payer_TRBHA HOPI]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA HOPI]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA HOPI]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA HOPI]|[plan_MEDICAID ] standard_charge|[payer_TRBHA HOPI]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA HOPI]|[plan_MEDICAID ] standard_charge|[payer_TRBHA NAVAJO]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA NAVAJO]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA NAVAJO]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA NAVAJO]|[plan_MEDICAID ] standard_charge|[payer_TRBHA NAVAJO]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA NAVAJO]|[plan_MEDICAID ] standard_charge|[payer_TRBHA PASCUA YAQUI]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA PASCUA YAQUI]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA PASCUA YAQUI]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA PASCUA YAQUI]|[plan_MEDICAID ] standard_charge|[payer_TRBHA PASCUA YAQUI]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA PASCUA YAQUI]|[plan_MEDICAID ] standard_charge|[payer_TRBHA TOHONO O ODHAM]|[plan_MEDICAID ]| negotiated_dollar standard_charge|[payer_TRBHA TOHONO O ODHAM]|[plan_MEDICAID ] |negotiated_percentage standard_charge|[payer_TRBHA TOHONO O ODHAM]|[plan_MEDICAID ] |negotiated_algorithm estimated_amount|[payer_TRBHA TOHONO O ODHAM]|[plan_MEDICAID ] standard_charge|[payer_TRBHA TOHONO O ODHAM]|[plan_MEDICAID ] |methodology additional_payer_notes|[payer_TRBHA TOHONO O ODHAM]|[plan_MEDICAID ] standard_charge|[payer_TRICARE EAST HUMANA]|[plan_TRICARE]| negotiated_dollar standard_charge|[payer_TRICARE EAST HUMANA]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST HUMANA]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST HUMANA]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST HUMANA]|[plan_TRICARE] |methodology additional_payer_notes|[payer_TRICARE EAST HUMANA]|[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 WEST]|[plan_TRICARE]| negotiated_dollar standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE WEST]|[plan_TRICARE] standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |methodology additional_payer_notes|[payer_TRICARE WEST]|[plan_TRICARE] standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_UBH MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN]|[plan_MANAGED MEDICAID]| negotiated_dollar standard_charge|[payer_UHC COMMUNITY PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC COMMUNITY PLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes|[payer_UHC COMMUNITY PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHC 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 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_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 MEDICAL RESOURCES]|[plan_HMO/PPO]| negotiated_dollar standard_charge|[payer_UNITED MEDICAL RESOURCES]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED MEDICAL RESOURCES]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED MEDICAL RESOURCES]|[plan_HMO/PPO] standard_charge|[payer_UNITED MEDICAL RESOURCES]|[plan_HMO/PPO] |methodology additional_payer_notes|[payer_UNITED MEDICAL RESOURCES]|[plan_HMO/PPO] standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL]| negotiated_dollar standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes|[payer_UPMC HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_WELLCARE MEDICARE]|[plan_MANAGED MEDICARE]| negotiated_dollar standard_charge|[payer_WELLCARE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes|[payer_WELLCARE MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_WINDOW ROCK T36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_WINDOW ROCK T36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_WINDOW ROCK T36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_WINDOW ROCK T36]|[plan_LOCAL GOVT] standard_charge|[payer_WINDOW ROCK T36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_WINDOW ROCK T36]|[plan_LOCAL GOVT] standard_charge|[payer_YOEME HEALTH CARE]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_YOEME HEALTH CARE]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_YOEME HEALTH CARE]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_YOEME HEALTH CARE]|[plan_LOCAL GOVT] standard_charge|[payer_YOEME HEALTH CARE]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_YOEME HEALTH CARE]|[plan_LOCAL GOVT] standard_charge|[payer_YUMA COUNTY TITLE 36]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_YUMA COUNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_YUMA COUNTY TITLE 36]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_YUMA COUNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_YUMA COUNTY TITLE 36]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_YUMA COUNTY TITLE 36]|[plan_LOCAL GOVT] standard_charge|[payer_YUMA COUNTY VICTIM SERV]|[plan_LOCAL GOVT]| negotiated_dollar standard_charge|[payer_YUMA COUNTY VICTIM SERV]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_YUMA COUNTY VICTIM SERV]|[plan_LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_YUMA COUNTY VICTIM SERV]|[plan_LOCAL GOVT] standard_charge|[payer_YUMA COUNTY VICTIM SERV]|[plan_LOCAL GOVT] |methodology additional_payer_notes|[payer_YUMA COUNTY VICTIM SERV]|[plan_LOCAL GOVT] additional_generic_notes ADULT PSYCH SEMI ROOM AND BOARD 124 RC facility inpatient 2230 850 816.39 2230 2230 per diem 1048 per diem 1048 per diem 853.12 per diem 853.12 per diem 853.12 per diem 816.39 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 1023.75 per diem 853.12 per diem 2230 per diem 996 per diem 2230 per diem 1550.32 per diem 853.12 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1045 per diem 2230 per diem 853.12 per diem 853.12 per diem 2230 per diem 1181 per diem 1345 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 1045 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 870.18 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem CHILD MENTAL HEALTH 124 RC facility inpatient 2230 850 816.39 2230 2230 per diem 1048 per diem 1048 per diem 853.12 per diem 853.12 per diem 853.12 per diem 816.39 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 1023.75 per diem 853.12 per diem 2230 per diem 996 per diem 2230 per diem 1550.32 per diem 853.12 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1045 per diem 2230 per diem 853.12 per diem 853.12 per diem 2230 per diem 1181 per diem 1345 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 1045 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 870.18 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem CHILD SEMI PRIV MH 124 RC facility inpatient 2230 850 816.39 2230 2230 per diem 1048 per diem 1048 per diem 853.12 per diem 853.12 per diem 853.12 per diem 816.39 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 1023.75 per diem 853.12 per diem 2230 per diem 996 per diem 2230 per diem 1550.32 per diem 853.12 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1045 per diem 2230 per diem 853.12 per diem 853.12 per diem 2230 per diem 1181 per diem 1345 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 1045 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 870.18 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem PSYCH CHILD SEMI ROOM AND BOARD 124 RC facility inpatient 2230 850 816.39 2230 2230 per diem 1048 per diem 1048 per diem 853.12 per diem 853.12 per diem 853.12 per diem 816.39 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 1023.75 per diem 853.12 per diem 2230 per diem 996 per diem 2230 per diem 1550.32 per diem 853.12 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1045 per diem 2230 per diem 853.12 per diem 853.12 per diem 2230 per diem 1181 per diem 1345 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 1045 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 870.18 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem PSYCH YOUTH SEMI PVT 124 RC facility inpatient 2230 850 816.39 2230 2230 per diem 1048 per diem 1048 per diem 853.12 per diem 853.12 per diem 853.12 per diem 816.39 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 1023.75 per diem 853.12 per diem 2230 per diem 996 per diem 2230 per diem 1550.32 per diem 853.12 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1045 per diem 2230 per diem 853.12 per diem 853.12 per diem 2230 per diem 1181 per diem 1345 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 1045 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 870.18 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem YOUTH MENTAL HEALTH 124 RC facility inpatient 2230 850 816.39 2230 2230 per diem 1048 per diem 1048 per diem 853.12 per diem 853.12 per diem 853.12 per diem 816.39 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 1023.75 per diem 853.12 per diem 2230 per diem 996 per diem 2230 per diem 1550.32 per diem 853.12 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 853.12 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1045 per diem 2230 per diem 853.12 per diem 853.12 per diem 2230 per diem 1181 per diem 1345 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 1045 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 853.12 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 870.18 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem ADULT DETOX SEMI ROOM AND BOARD 126 RC facility inpatient 2230 850 739.87 2230 2230 per diem 1048 per diem 1048 per diem 773.16 per diem 773.16 per diem 773.16 per diem 739.87 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 950 per diem 927.79 per diem 773.16 per diem 2230 per diem 996 per diem 2230 per diem 1309.15 per diem 773.16 per diem 850 per diem 2230 per diem 2230 per diem 2230 per diem 1124 per diem 1124 per diem 2230 per diem 773.16 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 773.16 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1048 per diem 2230 per diem 2230 per diem 2230 per diem 990 per diem 2230 per diem 1124 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 773.16 per diem 2230 per diem 2230 per diem 925 per diem 2230 per diem 2230 per diem 1030 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 985 per diem 2230 per diem 773.16 per diem 773.16 per diem 2230 per diem 1181 per diem 1500 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 940 per diem 1050 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 1100 per diem 2230 per diem 985 per diem 773.16 per diem 773.16 per diem 773.16 per diem 773.16 per diem 773.16 per diem 773.16 per diem 773.16 per diem 2230 per diem 2230 per diem 1386 per diem 919 per diem 788.62 per diem 919 per diem 990 per diem 990 per diem 990 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem 2230 per diem ELECTROCONVULSIVE THERAPY IP 901 RC facility inpatient 1380 440 72.64 2774 1380 per diem 2096 per diem 2096 per diem 72.64 per diem 1380 per diem 1380 per diem 1380 per diem 494.95 per diem 1380 per diem 950 per diem 1724.26 per diem 494.95 per diem 72.64 per diem 393.19 per diem 393.19 per diem 393.19 per diem 494.95 per diem 1168 per diem 2774 per diem 72.64 per diem 1380 per diem 1380 per diem 2192 per diem 2192 per diem 1048 per diem 1380 per diem 1755 per diem 1096 per diem 72.64 per diem 1380 per diem 1980 per diem 494.95 per diem 1380 per diem 1380 per diem 2076 per diem 494.95 per diem 494.95 per diem 72.64 per diem 72.64 per diem 1380 per diem 1933 per diem 494.95 per diem 1380 per diem 1380 per diem 1380 per diem 2680 per diem 1380 per diem 1038 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 1380 per diem 1380 per diem 1685 per diem 330.5 per diem 1685 per diem 825 per diem 1755 per diem 1755 per diem ELECTROCONVULSIVE THERAPY OP 901 RC facility outpatient 1380 440 72.64 2774 1380 per diem 2096 per diem 2096 per diem 72.64 per diem 1380 per diem 1380 per diem 1380 per diem 494.95 per diem 1380 per diem 950 per diem 1724.26 per diem 494.95 per diem 72.64 per diem 393.19 per diem 393.19 per diem 393.19 per diem 494.95 per diem 1168 per diem 2774 per diem 72.64 per diem 1380 per diem 1380 per diem 2192 per diem 2192 per diem 1048 per diem 1380 per diem 1755 per diem 1096 per diem 72.64 per diem 1380 per diem 1980 per diem 494.95 per diem 1380 per diem 1380 per diem 2076 per diem 494.95 per diem 494.95 per diem 72.64 per diem 72.64 per diem 1380 per diem 1933 per diem 494.95 per diem 1380 per diem 1380 per diem 1380 per diem 2680 per diem 1380 per diem 1038 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 72.64 per diem 1380 per diem 1380 per diem 1685 per diem 330.5 per diem 1685 per diem 825 per diem 1755 per diem 1755 per diem INTENSIVE OUTPATIENT PROGRAM ADULT PSY-CENPAT 905 RC facility outpatient 671 150 190 671 671 per diem 243 per diem 243 per diem 377.81 per diem 377.81 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 377.81 per diem 234.9 per diem 234.9 per diem 234.9 per diem 243 per diem 373.54 per diem 377.81 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 671 per diem 671 per diem 190 per diem 224 per diem 377.81 per diem 265 per diem 325 per diem 671 per diem 274 per diem 377.81 per diem 377.81 per diem 671 per diem 275 per diem 671 per diem 671 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 671 per diem 372 per diem 190 per diem 370.41 per diem 190 per diem 190 per diem 190 per diem INTENSIVE OUTPATIENT PROGRAM MH GROUP ADOL 905 RC facility outpatient 671 150 190 671 671 per diem 243 per diem 243 per diem 377.81 per diem 377.81 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 377.81 per diem 234.9 per diem 234.9 per diem 234.9 per diem 243 per diem 373.54 per diem 377.81 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 671 per diem 671 per diem 190 per diem 224 per diem 377.81 per diem 265 per diem 325 per diem 671 per diem 274 per diem 377.81 per diem 377.81 per diem 671 per diem 275 per diem 671 per diem 671 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 671 per diem 372 per diem 190 per diem 370.41 per diem 190 per diem 190 per diem 190 per diem INTENSIVE OUTPATIENT PROGRAM MH GROUP ADULT 905 RC facility outpatient 671 150 190 671 671 per diem 243 per diem 243 per diem 377.81 per diem 377.81 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 377.81 per diem 234.9 per diem 234.9 per diem 234.9 per diem 243 per diem 373.54 per diem 377.81 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 671 per diem 671 per diem 190 per diem 224 per diem 377.81 per diem 265 per diem 325 per diem 671 per diem 274 per diem 377.81 per diem 377.81 per diem 671 per diem 275 per diem 671 per diem 671 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 671 per diem 372 per diem 190 per diem 370.41 per diem 190 per diem 190 per diem 190 per diem INTENSIVE OUTPATIENT PROGRAM MH GRP THERAPY 905 RC facility outpatient 224 150 190 671 671 per diem 243 per diem 243 per diem 377.81 per diem 377.81 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 377.81 per diem 234.9 per diem 234.9 per diem 234.9 per diem 243 per diem 373.54 per diem 377.81 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 671 per diem 671 per diem 190 per diem 224 per diem 377.81 per diem 265 per diem 325 per diem 671 per diem 274 per diem 377.81 per diem 377.81 per diem 671 per diem 275 per diem 671 per diem 671 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 671 per diem 372 per diem 190 per diem 370.41 per diem 190 per diem 190 per diem 190 per diem TELE INTENSIVE OUTPATIENT PROGRAM MH 905 RC facility outpatient 671 150 190 671 671 per diem 243 per diem 243 per diem 377.81 per diem 377.81 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 377.81 per diem 234.9 per diem 234.9 per diem 234.9 per diem 243 per diem 373.54 per diem 377.81 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 671 per diem 671 per diem 190 per diem 224 per diem 377.81 per diem 265 per diem 325 per diem 671 per diem 274 per diem 377.81 per diem 377.81 per diem 671 per diem 275 per diem 671 per diem 671 per diem 671 per diem 671 per diem 671 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 377.81 per diem 671 per diem 372 per diem 190 per diem 370.41 per diem 190 per diem 190 per diem 190 per diem INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY ADOLESCENT 906 RC facility outpatient 671 150 157.86 671 671 per diem 243 per diem 243 per diem 161.01 per diem 161.01 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 161.01 per diem 174 per diem 174 per diem 174 per diem 243 per diem 373.54 per diem 161.01 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 161.01 per diem 671 per diem 671 per diem 190 per diem 224 per diem 161.01 per diem 265 per diem 325 per diem 671 per diem 274 per diem 161.01 per diem 161.01 per diem 671 per diem 275 per diem 300 per diem 671 per diem 671 per diem 671 per diem 671 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 671 per diem 372 per diem 190 per diem 157.86 per diem 190 per diem 190 per diem 190 per diem INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY ADULT 906 RC facility outpatient 671 150 157.86 671 671 per diem 243 per diem 243 per diem 161.01 per diem 161.01 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 161.01 per diem 174 per diem 174 per diem 174 per diem 243 per diem 373.54 per diem 161.01 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 161.01 per diem 671 per diem 671 per diem 190 per diem 224 per diem 161.01 per diem 265 per diem 325 per diem 671 per diem 274 per diem 161.01 per diem 161.01 per diem 671 per diem 275 per diem 300 per diem 671 per diem 671 per diem 671 per diem 671 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 671 per diem 372 per diem 190 per diem 157.86 per diem 190 per diem 190 per diem 190 per diem TELE INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY 906 RC facility outpatient 671 150 157.86 671 671 per diem 243 per diem 243 per diem 161.01 per diem 161.01 per diem 671 per diem 671 per diem 671 per diem 250 per diem 204 per diem 161.01 per diem 174 per diem 174 per diem 174 per diem 243 per diem 373.54 per diem 161.01 per diem 200 per diem 671 per diem 230 per diem 230 per diem 671 per diem 671 per diem 671 per diem 161.01 per diem 671 per diem 671 per diem 190 per diem 224 per diem 161.01 per diem 265 per diem 325 per diem 671 per diem 274 per diem 161.01 per diem 161.01 per diem 671 per diem 275 per diem 300 per diem 671 per diem 671 per diem 671 per diem 671 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 161.01 per diem 671 per diem 372 per diem 190 per diem 157.86 per diem 190 per diem 190 per diem 190 per diem PARTIAL HOSPITAL PROGRAM CHEMICAL DEPENDENCY 912 RC facility outpatient 1118 350 269.7 1118 441 per diem 436 per diem 1118 per diem 269.7 per diem 269.7 per diem 269.7 per diem 379 per diem 435.09 per diem 275 per diem 1118 per diem 457 per diem 457 per diem 1118 per diem 1118 per diem 292 per diem 446 per diem 350 per diem 463 per diem 1118 per diem 383 per diem 1118 per diem 485 per diem 1118 per diem 1118 per diem 1118 per diem 1118 per diem 1118 per diem 372 per diem 292 per diem 292 per diem 292 per diem 292 per diem PARTIAL HOSPITAL PROGRAM PSYCH ADOL 912 RC facility outpatient 1118 350 269.7 1118 441 per diem 436 per diem 1118 per diem 269.7 per diem 269.7 per diem 269.7 per diem 379 per diem 435.09 per diem 275 per diem 1118 per diem 457 per diem 457 per diem 1118 per diem 1118 per diem 292 per diem 446 per diem 350 per diem 463 per diem 1118 per diem 383 per diem 1118 per diem 485 per diem 1118 per diem 1118 per diem 1118 per diem 1118 per diem 1118 per diem 372 per diem 292 per diem 292 per diem 292 per diem 292 per diem INTENSIVE OUTPATIENT PROGRAM CHEMICAL DEPENDENCY PROCESS GRP 1 915 RC facility outpatient 224 200 372 243 per diem 232.97 per diem 232.97 per diem 232.97 per diem 200 per diem 232.97 per diem 232.97 per diem 232.97 per diem 232.97 per diem 232.97 per diem 224 per diem 372 per diem 232.97 per diem TELE CHEMICAL DEPENDENCY PROCESS GP 1 915 RC facility outpatient 224 224 436 436 per diem 274.61 per diem 274.61 per diem 274.61 per diem 275 per diem 274.61 per diem 274.61 per diem 274.61 per diem 274.61 per diem 274.61 per diem 224 per diem 372 per diem 274.61 per diem PARTIAL HOSPITAL PROGRAM CHEMICAL DEPENDENCY PSYCHED GRP 1 942 RC facility outpatient 224 224 224 224 per diem PARTIAL HOSPITAL PROGRAM MH PSYCHED GRP 1 942 RC facility outpatient 224 224 224 224 per diem Initial Eval - No Medical 90791 RC facility outpatient 260 30 194.55 30 fee schedule 30 fee schedule 163.78 fee schedule 163.78 fee schedule 162.24 fee schedule 163.78 fee schedule 146.68 fee schedule 194.55 fee schedule 160.02 fee schedule 95.16 fee schedule 95.16 fee schedule 159.42 fee schedule 146.68 fee schedule 88.55 fee schedule 88.55 fee schedule 127.12 fee schedule 73.85 fee schedule 160.49 fee schedule 160.49 fee schedule 140.36 fee schedule 142.47 fee schedule 134.01 fee schedule 160.81 fee schedule 135.61 fee schedule 87.43 fee schedule Initial Eval - With Medical 90792 RC facility outpatient 310 85.04 219.23 182.69 fee schedule 166.92 fee schedule 219.23 fee schedule 182.69 fee schedule 85.04 fee schedule 85.04 fee schedule 138 fee schedule 98.28 fee schedule Est Patient/med Management/low Complex 99213 RC facility outpatient 175 64.9 64.9 64.9 fee schedule Initial Hospital Care (30 Min) 99221 RC facility outpatient 110 32.23 89.89 72.26 fee schedule 86.71 fee schedule 89.89 fee schedule 57.32 fee schedule 57.32 fee schedule 80.03 fee schedule 32.23 fee schedule 80.97 fee schedule 76.03 fee schedule Initial Hospital Care (50 Min) 99222 RC facility outpatient 190 44.32 137.37 118.45 fee schedule 118.45 fee schedule 118.45 fee schedule 125.53 fee schedule 137.37 fee schedule 114.47 fee schedule 44.32 fee schedule 119.26 fee schedule 119.26 fee schedule 95.44 fee schedule Initial Hospital Care (70 Min) 99223 RC facility outpatient 260 177.56 177.56 177.56 fee schedule Subseq Care (15 Min) 99231 RC facility outpatient 160 22.22 49.49 40.94 fee schedule 40.94 fee schedule 42.43 fee schedule 40.94 fee schedule 47.88 fee schedule 48.86 fee schedule 49.49 fee schedule 42.98 fee schedule 29.35 fee schedule 29.35 fee schedule 40.59 fee schedule 40.78 fee schedule 41.65 fee schedule 47.88 fee schedule 41.36 fee schedule 41.36 fee schedule 41.5 fee schedule 22.22 fee schedule 42.26 fee schedule 35.65 fee schedule 37.57 fee schedule 48 fee schedule 42.19 fee schedule 43.16 fee schedule 41.82 fee schedule 44.92 fee schedule 37.74 fee schedule Subseq Care (25 Min) 99232 RC facility outpatient 260 15.98 91.76 49.71 fee schedule 49.71 fee schedule 68.93 fee schedule 68.93 fee schedule 68.97 fee schedule 68.93 fee schedule 76.36 fee schedule 82.2 fee schedule 67.74 fee schedule 46.34 fee schedule 46.34 fee schedule 65.22 fee schedule 91.76 fee schedule 82.75 fee schedule 76.36 fee schedule 58.75 fee schedule 58.75 fee schedule 54.07 fee schedule 54.07 fee schedule 70.25 fee schedule 38.17 fee schedule 60.53 fee schedule 65.23 fee schedule 48 fee schedule 20.42 fee schedule 59.38 fee schedule 66.97 fee schedule 65.86 fee schedule 39.35 fee schedule 15.98 fee schedule Subseq Care (35 Min) 99233 RC facility outpatient 390 48 124 92.71 fee schedule 92.71 fee schedule 104.79 fee schedule 92.71 fee schedule 124 fee schedule 98.75 fee schedule 69.63 fee schedule 69.63 fee schedule 48.15 fee schedule 91.79 fee schedule 48 fee schedule 72 fee schedule 105.83 fee schedule 109.13 fee schedule 93.63 fee schedule Discharge Day Mgmt <30 Min 99238 RC facility outpatient 115 39.05 84.49 69.55 fee schedule 69.55 fee schedule 68.18 fee schedule 69.55 fee schedule 77.88 fee schedule 83.27 fee schedule 69.29 fee schedule 50.1 fee schedule 50.1 fee schedule 69.76 fee schedule 67.44 fee schedule 77.88 fee schedule 41.56 fee schedule 41.56 fee schedule 77.88 fee schedule 39.05 fee schedule 70.46 fee schedule 67.36 fee schedule 40.11 fee schedule 59.61 fee schedule 82.53 fee schedule 69.36 fee schedule 84.49 fee schedule 56.76 fee schedule Initial Eval - No Medical with Modifier 95 9079195 RC facility outpatient 260 92.29 185.24 92.29 fee schedule 92.29 fee schedule 185.24 fee schedule 185.24 fee schedule Subseq Care (15 Min) with Modifier 95 9923195 RC facility outpatient 310 10.59 45.5 28.39 fee schedule 28.39 fee schedule 43.05 fee schedule 43.18 fee schedule 45.5 fee schedule 10.59 fee schedule