hospital_name last_updated_on version hospital_location hospital_address license_number|OK "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." "Rolling Hills Hospital, LLC" 5/31/2024 2.0.0 "Ada, Oklahoma" 1000 Rolling Hills Lane license_ 2319 | OK 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_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]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_AETNA]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_AETNA]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes |[payer_AETNA]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AETNA BETTER HEALTH OF KS]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AETNA BETTER HEALTH OF KS]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_AETNA BETTER HEALTH OF KS]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_AETNA BETTER HEALTH OF KS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_AETNA BETTER HEALTH OF KS]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes |[payer_AETNA BETTER HEALTH OF KS]|[plan_ MANAGED MEDICAID] standard_charge|[payer_ALL SAVERS]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALL SAVERS]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_ALL SAVERS]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_ALL SAVERS]|[plan_ COMMERCIAL] standard_charge|[payer_ALL SAVERS]|[plan_ COMMERCIAL]|methodology additional_payer_notes |[payer_ALL SAVERS]|[plan_ COMMERCIAL] 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_AMERIGROUP TEXAS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_AMERIGROUP TEXAS]|[plan_MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_AMERIGROUP TEXAS]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_AMERIGROUP TEXAS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_AMERIGROUP TEXAS]|[plan_MEDICAID: OUT OF STATE]|methodology additional_payer_notes |[payer_AMERIGROUP TEXAS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_ANOKA COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ANOKA COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_ANOKA COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ANOKA COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ANOKA COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ANOKA COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ANTHEM BCBS HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_ANTHEM BCBS HEALTHCARE]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS HEALTHCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_ANTHEM BCBS HEALTHCARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_ANTHEM BCBS HEALTHCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MANAGED MEDICAID]|[plan_HMO/PPO] standard_charge|[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_ARIZONA UHC COMMUNITYPLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_AZ CARE FIRST HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_AZ CARE FIRST HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_AZ CARE FIRST HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_AZ CARE FIRST HEALTH]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_AZ CARE FIRST HEALTH]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_AZ CARE FIRST HEALTH]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_AZ MERCY CARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_AZ MERCY CARE]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_AZ MERCY CARE]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_AZ MERCY CARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_AZ MERCY CARE]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_AZ MERCY CARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_BCBS OF OK]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF OK]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS OF OK]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS OF OK]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OF OK]|[plan_BLUE CROSS]|methodology additional_payer_notes |[payer_BCBS OF OK]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OF OK PPO ACUTE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF OK PPO ACUTE]|[plan_BLUE CROSS]|negotiated_percentage standard_charge|[payer_BCBS OF OK PPO ACUTE]|[plan_BLUE CROSS]|negotiated_algorithm estimated_amount|[payer_BCBS OF OK PPO ACUTE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OF OK PPO ACUTE]|[plan_BLUE CROSS]|methodology additional_payer_notes |[payer_BCBS OF OK PPO ACUTE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS]|[pan_ HMO]|negotiated_dollar standard_charge|[payer_BCBS]|[pan_ HMO]|negotiated_percentage standard_charge|[payer_BCBS]|[pan_ HMO]|negotiated_algorithm estimated_amount|[payer_BCBS]|[pan_ HMO] standard_charge|[payer_BCBS]|[pan_ HMO]|methodology additional_payer_notes |[payer_BCBS]|[pan_ HMO] 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_BEACON HEALTH OPTIONS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS]|[plan_MANAGED MEDICARE] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUECARE TN]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_BLUECARE TN]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_BLUECARE TN]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_BLUECARE TN]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_BLUECARE TN]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_BLUECARE TN]|[plan_MEDICAID: CBS OOS] 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_BUREAU OF INDIAN AFFAIRS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BUREAU OF INDIAN AFFAIRS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_BUREAU OF INDIAN AFFAIRS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_BUREAU OF INDIAN AFFAIRS]|[plan_LOCAL GOVT] standard_charge|[payer_BUREAU OF INDIAN AFFAIRS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_BUREAU OF INDIAN AFFAIRS]|[plan_LOCAL GOVT] standard_charge|[payer_BUTLER COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_BUTLER COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_BUTLER COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_BUTLER COUNTY]|[plan_LOCAL GOVT]| standard_charge|[payer_BUTLER COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_BUTLER COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_CHAMPVA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMPVA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHEROKEE NATION]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CHEROKEE NATION]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_CHEROKEE NATION]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_CHEROKEE NATION]|[plan_LOCAL GOVT] standard_charge|[payer_CHEROKEE NATION]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_CHEROKEE NATION]|[plan_LOCAL GOVT] standard_charge|[payer_CHICKASAW INDIAN HEALTH]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CHICKASAW INDIAN HEALTH]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_CHICKASAW INDIAN HEALTH]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_CHICKASAW INDIAN HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_CHICKASAW INDIAN HEALTH]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_CHICKASAW INDIAN HEALTH]|[plan_LOCAL GOVT] standard_charge|[payer_CHICKASAW NATION]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CHICKASAW NATION]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_CHICKASAW NATION]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_CHICKASAW NATION]|[plan_LOCAL GOVT] standard_charge|[payer_CHICKASAW NATION]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_CHICKASAW NATION]|[plan_LOCAL GOVT] 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 BEHAVORIAL HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CIGNA BEHAVORIAL HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_CIGNA BEHAVORIAL HEALTH]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CIGNA BEHAVORIAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CIGNA BEHAVORIAL HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_CIGNA BEHAVORIAL HEALTH]|[plan_HMO/PPO] standard_charge|[payer_CO ACCESS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO ACCESS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_CO ACCESS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_CO ACCESS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO ACCESS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_CO ACCESS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO CCHA]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO CCHA]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_CO CCHA]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_CO CCHA]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO CCHA]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_CO CCHA]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO EL PASO COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO EL PASO COUNTY]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_CO EL PASO COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_CO EL PASO COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO EL PASO COUNTY]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_CO EL PASO COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CO EPDST]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_CO EPDST]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_COMMUNITY CARE]|[plan_HMO/PPO] standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_COMMUNITY CARE]|[plan_HMO/PPO] standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO PHYSICIAN]|negotiated_dollar standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO PHYSICIAN]|negotiated_percentage standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO PHYSICIAN]|negotiated_algorithm estimated_amount|[payer_COMMUNITY CARE]|[plan_HMO/PPO PHYSICIAN] standard_charge|[payer_COMMUNITY CARE]|[plan_HMO/PPO PHYSICIAN]|methodology additional_payer_notes |[payer_COMMUNITY CARE]|[plan_HMO/PPO PHYSICIAN] 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_CONNECT CARE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_CONNECT CARE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_CONNECT CARE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_CONNECT CARE]|[plan_HMO/PPO] standard_charge|[payer_CONNECT CARE]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_CONNECT CARE]|[plan_HMO/PPO] standard_charge|[payer_CORNERSTONES OF CARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_CORNERSTONES OF CARE]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_CORNERSTONES OF CARE]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_CORNERSTONES OF CARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CORNERSTONES OF CARE]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_CORNERSTONES OF CARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_CUYAHOGA COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_CUYAHOGA COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_CUYAHOGA COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_CUYAHOGA COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_CUYAHOGA COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_CUYAHOGA COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_DANE COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_DANE COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_DANE COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_DANE COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_DANE COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_DANE COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_FIRST HEALTH NETWORK]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_FIRST HEALTH NETWORK]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_FIRST HEALTH NETWORK]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_FIRST HEALTH NETWORK]|[plan_HMO/PPO] standard_charge|[payer_FIRST HEALTH NETWORK]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_FIRST HEALTH NETWORK]|[plan_HMO/PPO] standard_charge|[payer_FISCAL SERVICES]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_FISCAL SERVICES]|[plan_MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_FISCAL SERVICES]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_FISCAL SERVICES]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_FISCAL SERVICES]|[plan_MEDICAID: OUT OF STATE]|methodology additional_payer_notes |[payer_FISCAL SERVICES]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_GILSBAR]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GILSBAR]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GILSBAR]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_GILSBAR]|[plan_COMMERCIAL] standard_charge|[payer_GILSBAR]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_GILSBAR]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH CHOICE|HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH CHOICE|HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTH CHOICE|HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTH CHOICE|HMO/PPO] standard_charge|[payer_HEALTH CHOICE|HMO/PPO]|methodology additional_payer_notes |[payer_HEALTH CHOICE|HMO/PPO] standard_charge|[payer_HEALTH CHOICE OF AZ]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HEALTH CHOICE OF AZ]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_HEALTH CHOICE OF AZ]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_HEALTH CHOICE OF AZ]|[plan_MANAGED MEDICAID]|[plan_HMO/PPO] standard_charge|[payer_HEALTH CHOICE OF AZ]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_HEALTH CHOICE OF AZ]|[plan_MANAGED MEDICAID] standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_HEALTH PLAN OF NEVADA]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_HEALTH PLAN OF NEVADA]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_HEALTH PLAN OF NEVADA]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTHCHOICE]|[plan_HMO/PPO] standard_charge|[payer_HEALTHCHOICE]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_HEALTHCHOICE]|[plan_HMO/PPO] standard_charge|[payer_HEALTHLINK]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTHLINK]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_HEALTHLINK]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_HEALTHLINK]|[plan_COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_HEALTHLINK]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_HEALTHLINK]|[plan_COMMERCIAL] standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO] |negotiated_dollar standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTHSMART]|[plan_HMO/PPO] standard_charge|[payer_HEALTHSMART]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_HEALTHSMART]|[plan_HMO/PPO] standard_charge|[payer_HI CAMHD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_HI CAMHD]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_HI CAMHD]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_HI CAMHD]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_HI CAMHD]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_HI CAMHD]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_HIGHMARK DELAWARE BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_HIGHMARK DELAWARE BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_HIGHMARK DELAWARE BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_HIGHMARK DELAWARE BCBS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_HIGHMARK DELAWARE BCBS]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_HIGHMARK DELAWARE BCBS]|[plan_MEDICAID: CBS OOS] 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 COMMERCIAL]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_HUMANA COMMERCIAL]|[plan_HMO/PPO] standard_charge|[payer_HUMANA MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_HUMANA MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_HUMANA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_HUMANA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA TRICARE]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_HUMANA TRICARE]|[plan_TRICARE]|negotiated_percentage standard_charge|[payer_HUMANA TRICARE]|[plan_TRICARE]|negotiated_algorithm estimated_amount|[payer_HUMANA TRICARE]|[plan_TRICARE] standard_charge|[payer_HUMANA TRICARE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_HUMANA TRICARE]|[plan_TRICARE] standard_charge|[payer_IA AMERIGROUP]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_IA AMERIGROUP]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_IA AMERIGROUP]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_IA AMERIGROUP]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_IA AMERIGROUP]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_IA AMERIGROUP]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_IA TOTAL CARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_IA TOTAL CARE]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_IA TOTAL CARE]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_IA TOTAL CARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_IA TOTAL CARE]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_IA TOTAL CARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_ID MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_ID MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_ID MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_ID MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_ID MEDICAID]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_ID MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_INDIANA DCS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_INDIANA DCS]|[plan_MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_INDIANA DCS]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_INDIANA DCS]|[plan_MEDICAID: OUT OF STATE]|[plan_HMO/PPO] standard_charge|[payer_INDIANA DCS]|[plan_MEDICAID: OUT OF STATE]|methodology additional_payer_notes |[payer_INDIANA DCS]|[plan_MEDICAID: OUT OF STATE] 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_KEMPTON GROUP]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_KEMPTON GROUP]|[plan_COMMERCIAL] standard_charge|[payer_KEMPTON GROUP]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_KEMPTON GROUP]|[plan_COMMERCIAL] standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_LA HEALTHCARE CONNECTIONS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_LA HEALTHCARE CONNECTIONS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_LARIMER COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_LARIMER COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_LARIMER COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_LARIMER COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_LARIMER COUNTY]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_LARIMER COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO] standard_charge|[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MAGELLAN BEHAVIORAL HEALT]|[plan_HMO/PPO] standard_charge|[payer_MAINECARE]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MAINECARE]|[plan_MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_MAINECARE]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_MAINECARE]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MAINECARE]|[plan_MEDICAID: OUT OF STATE]|methodology additional_payer_notes |[payer_MAINECARE]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MARYLAND PHYSICIANS CARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MARYLAND PHYSICIANS CARE]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MARYLAND PHYSICIANS CARE]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MARYLAND PHYSICIANS CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_MARYLAND PHYSICIANS CARE]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_MARYLAND PHYSICIANS CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_MD DHS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MD DHS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_MD DHS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_MD DHS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MD DHS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_MD DHS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_ME MAINECARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_ME MAINECARE]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_ME MAINECARE]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_ME MAINECARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_ME MAINECARE]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_ME MAINECARE]|[plan_MEDICAID: CBS OOS] 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_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_MESA COUNTY DHS/SOC SERV]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MESA COUNTY DHS/SOC SERV]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_MESA COUNTY DHS/SOC SERV]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_MESA COUNTY DHS/SOC SERV]|[plan_LOCAL GOVT] standard_charge|[payer_MESA COUNTY DHS/SOC SERV]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_MESA COUNTY DHS/SOC SERV]|[plan_LOCAL GOVT] standard_charge|[payer_MHNET]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MHNET]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_MHNET]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MHNET]|[plan_HMO/PPO]] standard_charge|[payer_MHNET]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_MHNET]|[plan_HMO/PPO] standard_charge|[payer_MISSOURI FAMILY FORWARD]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MISSOURI FAMILY FORWARD]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_MISSOURI FAMILY FORWARD]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_MISSOURI FAMILY FORWARD]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MISSOURI FAMILY FORWARD]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_MISSOURI FAMILY FORWARD]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MO DSS ]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MO DSS ]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_MO DSS ]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_MO DSS ]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MO DSS ]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_MO DSS ]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MOLINA HEALTHCARE OF MS]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OF MS]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OF MS]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OF MS]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF MS]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_MOLINA HEALTHCARE OF MS]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF WA]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTHCARE OF WA]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MOLINA HEALTHCARE OF WA]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MOLINA HEALTHCARE OF WA]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTHCARE OF WA]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_MOLINA HEALTHCARE OF WA]|[plan_MANAGED MEDICAID] standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_MONTANA MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MONTGOMERY COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_MONTGOMERY COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_MONTGOMERY COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_MONTGOMERY COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_MONTGOMERY COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_MONTGOMERY COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_MS MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_MS MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_MS MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_MS MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_MS MEDICAID]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_MS MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NE DHHS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_NE DHHS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_NE DHHS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_NE DHHS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NE DHHS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_NE DHHS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_NEVADA MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NH MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_NH MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_NH MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_NH MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NH MEDICAID]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_NH MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NM BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_NM BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_NM BCBS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_NM BCBS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NM BCBS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_NM BCBS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NM PRES MAGELLAN]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_NM PRES MAGELLAN]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_NM PRES MAGELLAN]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_NM PRES MAGELLAN]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_NM PRES MAGELLAN]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_NM PRES MAGELLAN]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH AETNA BETTER HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_OH AETNA BETTER HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_OH AETNA BETTER HEALTH]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_OH AETNA BETTER HEALTH]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH AETNA BETTER HEALTH]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_OH AETNA BETTER HEALTH]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH CUYAHOGA COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_OH CUYAHOGA COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_OH CUYAHOGA COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_OH CUYAHOGA COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH CUYAHOGA COUNTY]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_OH CUYAHOGA COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH FRANKLIN COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_OH FRANKLIN COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_OH FRANKLIN COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_OH FRANKLIN COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH FRANKLIN COUNTY]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_OH FRANKLIN COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH HAMILTON COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_OH HAMILTON COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_OH HAMILTON COUNTY]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_OH HAMILTON COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OH HAMILTON COUNTY]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_OH HAMILTON COUNTY]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OHIO MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_OHIO MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_OHIO MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_OHIO MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OHIO MEDICAID]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_OHIO MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_OK DEPT OF HUMAN SERVICES]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OK DEPT OF HUMAN SERVICES]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_OK DEPT OF HUMAN SERVICES]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_OK DEPT OF HUMAN SERVICES]|[plan_LOCAL GOVT] standard_charge|[payer_OK DEPT OF HUMAN SERVICES]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_OK DEPT OF HUMAN SERVICES]|[plan_LOCAL GOVT] standard_charge|[payer_OK MEDICAID RTC]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_OK MEDICAID RTC]|[plan_MEDICAID]|negotiated_percentage standard_charge|[payer_OK MEDICAID RTC]|[plan_MEDICAID]|negotiated_algorithm estimated_amount|[payer_OK MEDICAID RTC]|[plan_MEDICAID]|[plan_HMO/PPO] standard_charge|[payer_OK MEDICAID RTC]|[plan_MEDICAID]|methodology additional_payer_notes |[payer_OK MEDICAID RTC]|[plan_MEDICAID] standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID]|negotiated_dollar standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID]|negotiated_percentage standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID]|negotiated_algorithm estimated_amount|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID] standard_charge|[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID]|methodology additional_payer_notes |[payer_OKLAHOMA MEDICAID]|[plan_MEDICAID] standard_charge|[payer_ONEIDA COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_ONEIDA COUNTY]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_ONEIDA COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_ONEIDA COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_ONEIDA COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_ONEIDA COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_OPTUM HEALTH]|[plan_MANAGED MEDICARE] standard_charge|[payer_OREGON DHS]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_OREGON DHS]|[plan_MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_OREGON DHS]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_OREGON DHS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OREGON DHS]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_OREGON DHS]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_OSCAR HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_OSCAR HEALTH]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_OSCAR HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_OUTAGAMIE COUTNY DHS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_OUTAGAMIE COUTNY DHS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_OUTAGAMIE COUTNY DHS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_OUTAGAMIE COUTNY DHS]|[plan_LOCAL GOVT] standard_charge|[payer_OUTAGAMIE COUTNY DHS]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_OUTAGAMIE COUTNY DHS]|[plan_LOCAL GOVT] standard_charge|[payer_PINE COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_PINE COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_PINE COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_PINE COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_PINE COUNTY]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_PINE COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_POINT COMFORT UNDERWRITER]|[plan_LOCAL GOVT] standard_charge|[payer_POINT COMFORT UNDERWRITER]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_POINT COMFORT UNDERWRITER]|[plan_LOCAL GOVT] standard_charge|[payer_QUAPAW TRIBE]|[plan)LOCAL GOVT]|negotiated_dollar standard_charge|[payer_QUAPAW TRIBE]|[plan)LOCAL GOVT]|negotiated_percentage standard_charge|[payer_QUAPAW TRIBE]|[plan)LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_QUAPAW TRIBE]|[plan)LOCAL GOVT] standard_charge|[payer_QUAPAW TRIBE]|[plan)LOCAL GOVT] |methodology additional_payer_notes |[payer_QUAPAW TRIBE]|[plan)LOCAL GOVT] standard_charge|[payer_RAMSEY COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_RAMSEY COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_RAMSEY COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_RAMSEY COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_RAMSEY COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_RAMSEY COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_SALT RIVER PIMA]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_SALT RIVER PIMA]|[plan_LOCAL GOVT] |negotiated_percentage standard_charge|[payer_SALT RIVER PIMA]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_SALT RIVER PIMA]|[plan_LOCAL GOVT] standard_charge|[payer_SALT RIVER PIMA]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_SALT RIVER PIMA]|[plan_LOCAL GOVT] standard_charge|[payer_SAN DIEGO UNIFIED SCHOOL]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_SAN DIEGO UNIFIED SCHOOL]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_SAN DIEGO UNIFIED SCHOOL]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_SAN DIEGO UNIFIED SCHOOL]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_SAN DIEGO UNIFIED SCHOOL]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_SAN DIEGO UNIFIED SCHOOL]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_SELECT HEALTH OF SC]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_SELECT HEALTH OF SC]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_SELECT HEALTH OF SC]|[plan_MEDICAID: CBS OOS] |negotiated_algorithm estimated_amount|[payer_SELECT HEALTH OF SC]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_SELECT HEALTH OF SC]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_SELECT HEALTH OF SC]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_SICANGU CFS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_SICANGU CFS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_SICANGU CFS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_SICANGU CFS]|[plan_LOCAL GOVT] standard_charge|[payer_SICANGU CFS]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_SICANGU CFS]|[plan_LOCAL GOVT] standard_charge|[payer_SOUTH CAROLINA DSS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_SOUTH CAROLINA DSS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_SOUTH CAROLINA DSS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_SOUTH CAROLINA DSS]|[plan_LOCAL GOVT] standard_charge|[payer_SOUTH CAROLINA DSS]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_SOUTH CAROLINA DSS]|[plan_LOCAL GOVT] standard_charge|[payer_SOUTH DAKOTA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_SOUTH DAKOTA MEDICAID]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_SOUTH DAKOTA MEDICAID]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_SOUTH DAKOTA MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_SOUTH DAKOTA MEDICAID]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_SOUTH DAKOTA MEDICAID]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_STEARNS COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_STEARNS COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_STEARNS COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_STEARNS COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_STEARNS COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_STEARNS COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_SUNFLOWER HEALTH PLAN]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_SUNFLOWER HEALTH PLAN]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_SUNFLOWER HEALTH PLAN]|[plan_MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_SUNFLOWER HEALTH PLAN]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_SUNFLOWER HEALTH PLAN]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_SUNFLOWER HEALTH PLAN]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_SUNSHINE HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SUNSHINE HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SUNSHINE HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_SUNSHINE HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_SUNSHINE HEALTH PLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SUNSHINE HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT] standard_charge|[payer_TENNESSEE DCS]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_TENNESSEE DCS]|[plan_LOCAL GOVT] standard_charge|[payer_TN BLUECARE]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_TN BLUECARE]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_TN BLUECARE]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_TN BLUECARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_TN BLUECARE]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_TN BLUECARE]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_TN DCS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_TN DCS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_TN DCS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_TN DCS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_TN DCS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_TN DCS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_Tricare]|[plan_Tricare]|negotiated_dollar standard_charge|[payer_Tricare]|[plan_Tricare] |negotiated_percentage standard_charge|[payer_Tricare]|[plan_Tricare]|negotiated_algorithm estimated_amount|[payer_Tricare]|[plan_Tricare]|[plan_HMO/PPO] standard_charge|[payer_Tricare]|[plan_Tricare]|methodology additional_payer_notes |[payer_Tricare]|[plan_Tricare] standard_charge|[payer_TX DFPS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_TX DFPS]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_TX DFPS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_TX DFPS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_TX DFPS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_TX DFPS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_TX ST FRANCIS]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_TX ST FRANCIS]|[plan_MEDICAID: CBS OOS]|negotiated_percentage standard_charge|[payer_TX ST FRANCIS]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_TX ST FRANCIS]|[plan_MEDICAID: CBS OOS]|[plan_HMO/PPO] standard_charge|[payer_TX ST FRANCIS]|[plan_MEDICAID: CBS OOS]|methodology additional_payer_notes |[payer_TX ST FRANCIS]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_UBH MEDICA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH MEDICA]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UBH MEDICA]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UBH MEDICA]|[plan_HMO/PPO] standard_charge|[payer_UBH MEDICA]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UBH MEDICA]|[plan_HMO/PPO] standard_charge|[payer_UBH OPTUM]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH OPTUM]|[plan_HMO/PPO]|negotiated_percentage standard_charge|[payer_UBH OPTUM]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UBH OPTUM]|[plan_HMO/PPO] standard_charge|[payer_UBH OPTUM]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UBH OPTUM]|[plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UMR]|[plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UMR]|[plan_HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH]|[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_UNITED HEALTHCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE]|[plan_MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_UNITED HEALTHCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE INC]|[plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UNITED HEALTHCARE INC]|[plan_COMMERCIAL] standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE INC]|[plan_HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_HMO/PPO]|methodology additional_payer_notes |[payer_UNITED HEALTHCARE INC]|[plan_HMO/PPO] standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_UNITED HEALTHCARE INC]|[plan_MANAGED MEDICARE] standard_charge|[payer_UNITED HEALTHCARE INC]|[plan_MANAGED MEDICARE]|methodology additional_payer_notes |[payer_UNITED HEALTHCARE INC]|[plan_MANAGED MEDICARE] standard_charge|[payer_UNIVERSITY FAMILY CARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UNIVERSITY FAMILY CARE]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UNIVERSITY FAMILY CARE]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UNIVERSITY FAMILY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_UNIVERSITY FAMILY CARE]|[plan_MANAGED MEDICAID]|methodology additional_payer_notes |[payer_UNIVERSITY FAMILY CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_WEB TPA]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_WEB TPA]|[plan_COMMERCIAL]|negotiated_percentage standard_charge|[payer_WEB TPA]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_WEB TPA]|[plan_COMMERCIAL] standard_charge|[payer_WEB TPA]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_WEB TPA]|[plan_COMMERCIAL] standard_charge|[payer_WELL FIRST HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_WELL FIRST HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_WELL FIRST HEALTH]|[plan_COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_WELL FIRST HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_WELL FIRST HEALTH]|[plan_COMMERCIAL]|methodology additional_payer_notes |[payer_WELL FIRST HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_WESTERN SKY]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_WESTERN SKY]|[plan_MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_WESTERN SKY]|[plan_MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_WESTERN SKY]|[plan_MANAGED MEDICAID] standard_charge|[payer_WESTERN SKY]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_WESTERN SKY]|[plan_MANAGED MEDICAID] standard_charge|[payer_WISCONSIN DHHS]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_WISCONSIN DHHS]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_WISCONSIN DHHS]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_WISCONSIN DHHS]|[plan_LOCAL GOVT] standard_charge|[payer_WISCONSIN DHHS]|[plan_LOCAL GOVT] |methodology additional_payer_notes |[payer_WISCONSIN DHHS]|[plan_LOCAL GOVT] standard_charge|[payer_WV DHHR]|[plan_MEDICAID: CBS OOS]|negotiated_dollar standard_charge|[payer_WV DHHR]|[plan_MEDICAID: CBS OOS] |negotiated_percentage standard_charge|[payer_WV DHHR]|[plan_MEDICAID: CBS OOS]|negotiated_algorithm estimated_amount|[payer_WV DHHR]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_WV DHHR]|[plan_MEDICAID: CBS OOS] |methodology additional_payer_notes |[payer_WV DHHR]|[plan_MEDICAID: CBS OOS] standard_charge|[payer_WV DHHR MERCER COUNTY]|[plan_LOCAL GOVT]|negotiated_dollar standard_charge|[payer_WV DHHR MERCER COUNTY]|[plan_LOCAL GOVT]|negotiated_percentage standard_charge|[payer_WV DHHR MERCER COUNTY]|[plan_LOCAL GOVT]|negotiated_algorithm estimated_amount|[payer_WV DHHR MERCER COUNTY]|[plan_LOCAL GOVT] standard_charge|[payer_WV DHHR MERCER COUNTY]|[plan_LOCAL GOVT]|methodology additional_payer_notes |[payer_WV DHHR MERCER COUNTY]|[plan_LOCAL GOVT] standard_charge|min standard_charge | max additional_generic_notes ROOM AND BOARD ADULT PSYCH 124 RC Inpatient 2430 690 810 per diem 810 per diem 664.91 per diem 800 per diem 500 per diem 475 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 550 per diem 875 per diem 800 per diem 800 per diem 700 per diem 900 per diem 664.91 per diem 800 per diem 800 per diem 850 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 475 1275 ROOM AND BOARD GERIATRIC PSYCH 124 RC Inpatient 2430 690 810 per diem 810 per diem 664.91 per diem 800 per diem 500 per diem 475 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 550 per diem 875 per diem 800 per diem 800 per diem 700 per diem 900 per diem 664.91 per diem 800 per diem 800 per diem 850 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 475 1275 ROOM AND BOARD MRDD PSYCH 124 RC Inpatient 2430 690 810 per diem 810 per diem 664.91 per diem 800 per diem 500 per diem 475 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 550 per diem 875 per diem 800 per diem 800 per diem 700 per diem 900 per diem 664.91 per diem 800 per diem 800 per diem 850 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 475 1275 ROOM AND BOARD GERIATRIC PSYCH 124 RC Inpatient 2430 690 810 per diem 810 per diem 664.91 per diem 800 per diem 500 per diem 475 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 550 per diem 875 per diem 800 per diem 800 per diem 700 per diem 900 per diem 664.91 per diem 800 per diem 800 per diem 850 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 475 1275 ROOM AND BOARD MRDD PSYCH 124 RC Inpatient 2430 690 810 per diem 810 per diem 664.91 per diem 800 per diem 500 per diem 475 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 550 per diem 875 per diem 800 per diem 800 per diem 700 per diem 900 per diem 664.91 per diem 800 per diem 800 per diem 850 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 475 1275 ROOM AND BOARD ADULT DETOX 126 RC Inpatient 2430 690 559 per diem 559 per diem 800 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 875 per diem 800 per diem 800 per diem 700 per diem 664.91 per diem 800 per diem 800 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 500 1275 ROOM AND BOARD GERIATRIC DETOX 126 RC Inpatient 2430 690 559 per diem 559 per diem 800 per diem 550 per diem 817 per diem 720 per diem 665 per diem 850 per diem 850 per diem 1275 per diem 817 per diem 863 per diem 900 per diem 670 per diem 840 per diem 850 per diem 800 per diem 944 per diem 500 per diem 700 per diem 875 per diem 800 per diem 800 per diem 700 per diem 664.91 per diem 800 per diem 800 per diem 925 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 500 1275 ROOM AND BOARD ADULT REHAB 128 RC Inpatient 2430 690 440 per diem 800 per diem 440 800 INTENSIVE OUTPATIENT PROGRAM AUDLT 905 RC Outpatient 618 160 233 per diem 168 per diem 212 per diem 213 per diem 472 per diem 206 per diem 200 per diem 160 per diem 192 per diem 192 per diem 192 per diem 384 per diem 192 per diem 181 per diem 160 472 PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC Outpatient 824 210 437 per diem 220 per diem 371 per diem 400 per diem 640 per diem 206 per diem 206 per diem 160 per diem 440 per diem 440 per diem 440 per diem 880 per diem 440 per diem 160 880 INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 1 915 RC Outpatient 206 55 204 per diem 206 per diem 206 per diem 160 per diem 192 per diem 880 per diem 160 880 PARTIAL HOSPITAL PROGRAM PROCESS GROUP 1 915 RC Outpatient 165 42 204 per diem 206 per diem 206 per diem 160 per diem 192 per diem 880 per diem 160 880 BLOCKED BED 1001 RC Outpatient 310 250 478 per diem 550 per diem 436 per diem 550 per diem 480 per diem 425 per diem 500 per diem 475 per diem 550 per diem 534 per diem 481 per diem 399 per diem 550 per diem 817 per diem 436 per diem 500 per diem 759 per diem 525 per diem 669 per diem 765 per diem 787 per diem 925 per diem 485 per diem 380 per diem 630 per diem 500 per diem 620 per diem 550 per diem 436 per diem 570 per diem 458 per diem 944 per diem 500 per diem 481 per diem 944 per diem 500 per diem 418 per diem 550 per diem 350 per diem 350 per diem 495 per diem 550 per diem 550 per diem 545 per diem 450 per diem 1000 per diem 424 per diem 480 per diem 480 per diem 436 per diem 1128 per diem 436 per diem 450 per diem 500 per diem 436 per diem 450 per diem 500 per diem 525 per diem 550 per diem 900 per diem 459 per diem 400 per diem 690 per diem 469 per diem 425 per diem 391 per diem 450 per diem 480 per diem 550 per diem 475 per diem 509 per diem 489 per diem 500 per diem 870 per diem 790 per diem 570 per diem 545 per diem 525 per diem 480 per diem 450 per diem 525 per diem 480 per diem 600 per diem 628 per diem 550 per diem 475 per diem 550 per diem 475 per diem 500 per diem 500 per diem 670 per diem 500 per diem 670 per diem 475 per diem 565 per diem 565 per diem 436 per diem 436 per diem 505 per diem 436 per diem 436 per diem 475 per diem 500 per diem 450 per diem 450 per diem 615 per diem 615 per diem 350 1128 RESIDENTIAL TREATMENT CENTER 1001 RC Outpatient 1763 505 478 per diem 550 per diem 436 per diem 550 per diem 480 per diem 425 per diem 500 per diem 475 per diem 550 per diem 534 per diem 481 per diem 399 per diem 550 per diem 817 per diem 436 per diem 500 per diem 759 per diem 525 per diem 669 per diem 765 per diem 787 per diem 925 per diem 485 per diem 380 per diem 630 per diem 500 per diem 620 per diem 550 per diem 436 per diem 570 per diem 458 per diem 944 per diem 500 per diem 481 per diem 944 per diem 500 per diem 418 per diem 550 per diem 350 per diem 350 per diem 495 per diem 550 per diem 550 per diem 545 per diem 450 per diem 1000 per diem 424 per diem 480 per diem 480 per diem 436 per diem 1128 per diem 436 per diem 450 per diem 500 per diem 436 per diem 450 per diem 500 per diem 525 per diem 550 per diem 900 per diem 459 per diem 400 per diem 690 per diem 469 per diem 425 per diem 391 per diem 450 per diem 480 per diem 550 per diem 475 per diem 509 per diem 489 per diem 500 per diem 870 per diem 790 per diem 570 per diem 545 per diem 525 per diem 480 per diem 450 per diem 525 per diem 480 per diem 600 per diem 628 per diem 550 per diem 475 per diem 550 per diem 475 per diem 500 per diem 500 per diem 670 per diem 500 per diem 670 per diem 475 per diem 565 per diem 565 per diem 436 per diem 436 per diem 505 per diem 436 per diem 436 per diem 475 per diem 500 per diem 450 per diem 450 per diem 615 per diem 615 per diem 350 1128