hospital_name last_updated_on version hospital_location hospital_address license_number|TN "To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated." "Crestwyn Health Group, LLC" 5/31/2024 2.0.0 "Memphis, Tennessee" 9485 Crestwyn Hills Drive license_ L000000032695 |TN TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement modifiers standard_charge | gross standard_charge|discounted_cash standard_charge|min standard_charge | max standard_charge|[payer_AARP UHC]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AARP UHC]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AARP UHC]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AARP UHC]|[plan_MANAGED MEDICAID] standard_charge|[payer_AARP UHC]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AARP UHC]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AARP UHC MEDICARE ADV]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AARP UHC MEDICARE ADV]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AARP UHC MEDICARE ADV]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AARP UHC MEDICARE ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_AARP UHC MEDICARE ADV]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AARP UHC MEDICARE ADV]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AETNA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA]|[plan_HMO/PPO] standard_charge|[payer_AETNA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AETNA]|[Plan_HMO/PPO] standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALLWELL]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALLWELL]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALLWELL]|[plan_MANAGED MEDICARE] standard_charge|[payer_ALLWELL]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ALLWELL]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AMBETTER COMMERCIAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AMBETTER COMMERCIAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AMBETTER COMMERCIAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AMBETTER COMMERCIAL]|[plan_COMMERCIAL] standard_charge|[payer_AMBETTER COMMERCIAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AMBETTER COMMERCIAL]|[Plan_COMMERCIAL] standard_charge|[payer_AMBETTER MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_AMBETTER MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_AMBETTER MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_AMBETTER MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_AMBETTER MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_AMBETTER MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_AMERIBEN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_AMERIBEN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_AMERIBEN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AMERIBEN]|[plan_HMO/PPO] standard_charge|[payer_AMERIBEN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_AMERIBEN]|[Plan_HMO/PPO] standard_charge|[payer_AMERICAN BEHAVIORAL HLTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AMERICAN BEHAVIORAL HLTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AMERICAN BEHAVIORAL HLTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AMERICAN BEHAVIORAL HLTH]|[plan_COMMERCIAL] standard_charge|[payer_AMERICAN BEHAVIORAL HLTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AMERICAN BEHAVIORAL HLTH]|[Plan_COMMERCIAL] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_AMERIGROUP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_AMERIGROUP-MEDICARE ADV]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIGROUP-MEDICARE ADV]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIGROUP-MEDICARE ADV]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIGROUP-MEDICARE ADV]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMERIGROUP-MEDICARE ADV]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIGROUP-MEDICARE ADV]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] standard_charge|[payer_ANTHEM BCBS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_ANTHEM BCBS]|[Plan_BLUE CROSS] standard_charge|[payer_AR MEDICAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_AR MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_AR MEDICAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_AR MEDICAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_AR MEDICAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_AR MEDICAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_ARKANSAS WELLCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ARKANSAS WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ARKANSAS WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ARKANSAS WELLCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_ARKANSAS WELLCARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ARKANSAS WELLCARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] standard_charge|[payer_BCBS FEDERAL]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS FEDERAL]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OF TENNESSEE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OF TENNESSEE]|[Plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS OUT OF STATE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OUT OF STATE]|[Plan_BLUE CROSS] standard_charge|[payer_BEACON HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEACON HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEACON HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_BEACON HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BEACON HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BLUE CARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_BLUE CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_BLUE CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_BLUE CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_BLUE CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_BLUE CARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_BLUE CARE PLUS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE CARE PLUS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE CARE PLUS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE CARE PLUS]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUE CARE PLUS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUE CARE PLUS]|[Plan_MANAGED MEDICARE] standard_charge|[payer_BRIGHT HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BRIGHT HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BRIGHT HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BRIGHT HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_BRIGHT HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BRIGHT HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_CENPATICO MAGNOLIA HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_CENPATICO MAGNOLIA HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_CENPATICO MAGNOLIA HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_CENPATICO MAGNOLIA HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_CENPATICO MAGNOLIA HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_CENPATICO MAGNOLIA HEALTH]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMPVA]|[plan_VETERANS ADMIN] standard_charge|[payer_CHAMPVA]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMPVA]|[Plan_VETERANS ADMIN] standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY]|negotiated_dollar standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY] |negotiated_percentage standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY] |negotiated_algorithm estimated_amount|[payer_CHARITY]|[plan_SELF PAY CHARITY] standard_charge|[payer_CHARITY]|[plan_SELF PAY CHARITY] |methodology additional_payer_notes |[payer_CHARITY]|[Plan_SELF PAY CHARITY] 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 HEALTHSPRING]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTHSPRING]|[Plan_MANAGED MEDICARE] standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_COMPSYCH]|[plan_COMMERCIAL] standard_charge|[payer_COMPSYCH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_COMPSYCH]|[Plan_COMMERCIAL] standard_charge|[payer_COVER KIDS/BCBS TN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_COVER KIDS/BCBS TN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_COVER KIDS/BCBS TN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_COVER KIDS/BCBS TN]|[plan_MANAGED MEDICAID] standard_charge|[payer_COVER KIDS/BCBS TN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_COVER KIDS/BCBS TN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_CYPRESS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_CYPRESS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_CYPRESS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CYPRESS]|[plan_COMMERCIAL] standard_charge|[payer_CYPRESS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_CYPRESS]|[Plan_COMMERCIAL] standard_charge|[payer_EXCELLUS BCBS]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_EXCELLUS BCBS]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_EXCELLUS BCBS]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_EXCELLUS BCBS]|[plan_BLUE CROSS] standard_charge|[payer_EXCELLUS BCBS]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_EXCELLUS BCBS]|[Plan_BLUE CROSS] standard_charge|[payer_GEHA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_GEHA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_GEHA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_GEHA]|[plan_HMO/PPO] standard_charge|[payer_GEHA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_GEHA]|[Plan_HMO/PPO] standard_charge|[payer_HEALTH COST SOLUTIONS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTH COST SOLUTIONS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTH COST SOLUTIONS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTH COST SOLUTIONS]|[plan_COMMERCIAL] standard_charge|[payer_HEALTH COST SOLUTIONS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTH COST SOLUTIONS]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] standard_charge|[payer_HEALTHPARTNERS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHPARTNERS]|[Plan_HMO/PPO] standard_charge|[payer_HEALTHSCOPE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTHSCOPE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTHSCOPE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTHSCOPE]|[plan_COMMERCIAL] standard_charge|[payer_HEALTHSCOPE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTHSCOPE]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTHSMART]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTHSMART]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_HEALTHSMART]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_HEALTHSMART]|[plan_COMMERCIAL] standard_charge|[payer_HEALTHSMART]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_HEALTHSMART]|[Plan_COMMERCIAL] 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 MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE ADVANTAGE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_KAISER PERMANENTE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_KAISER PERMANENTE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_KAISER PERMANENTE]|[plan_MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_KAISER PERMANENTE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_LUCENT HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_LUCENT HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_MEDBEN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MEDBEN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MEDBEN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MEDBEN]|[plan_COMMERCIAL] standard_charge|[payer_MEDBEN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MEDBEN]|[Plan_COMMERCIAL] 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_MEDICARE OUTPATIENT]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE OUTPATIENT]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE OUTPATIENT]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE OUTPATIENT]|[plan_MEDICARE] standard_charge|[payer_MEDICARE OUTPATIENT]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE OUTPATIENT]|[Plan_MEDICARE] standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MERITAIN HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MISC COMMERCIAL]|[Plan_COMMERCIAL] standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MISC HMO PPO]|[plan_HMO/PPO] standard_charge|[payer_MISC HMO PPO]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MISC HMO PPO]|[Plan_HMO/PPO] standard_charge|[payer_MISC MGD MCAID]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MGD MCAID]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MISC MGD MCAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCAID]|[plan_MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCAID]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MISC MGD MCAID]|[Plan_MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MISC MGD MCARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MISC OOS MCAID]|[plan_MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MISC OOS MCAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_percentage standard_charge|[payer_MISC OOS MCAID]|[plan_MEDICAID: OUT OF STATE] |negotiated_algorithm estimated_amount|[payer_MISC OOS MCAID]|[plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MISC OOS MCAID]|[plan_MEDICAID: OUT OF STATE] |methodology additional_payer_notes |[payer_MISC OOS MCAID]|[Plan_MEDICAID: OUT OF STATE] standard_charge|[payer_MOLINA HEALTH]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA HEALTH]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_MOLINA HEALTH]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_MOLINA HEALTH]|[plan_MANAGED MEDICAID] standard_charge|[payer_MOLINA HEALTH]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_MOLINA HEALTH]|[Plan_MANAGED MEDICAID] 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_OPTUM HEALTH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM HEALTH]|[plan_HMO/PPO] standard_charge|[payer_OPTUM HEALTH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM HEALTH]|[Plan_HMO/PPO] standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] standard_charge|[payer_PHILADELPHIA AMERICAN LIF]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_PHILADELPHIA AMERICAN LIF]|[Plan_COMMERCIAL] 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] standard_charge|[payer_TRICARE]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE]|[Plan_TRICARE] standard_charge|[payer_UBH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UBH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UBH]|[plan_HMO/PPO] standard_charge|[payer_UBH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UBH]|[Plan_HMO/PPO] standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE HMO]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UBH MEDICARE HMO]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHC COMMUNITY PLAN MS CHP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY PLAN MS CHP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC COMMUNITY PLAN MS CHP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY PLAN MS CHP]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN MS CHP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC COMMUNITY PLAN MS CHP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN TNCARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY PLAN TNCARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_UHC COMMUNITY PLAN TNCARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY PLAN TNCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN TNCARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_UHC COMMUNITY PLAN TNCARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_UHC OF RIVER VALLEY]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC OF RIVER VALLEY]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC OF RIVER VALLEY]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC OF RIVER VALLEY]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC OF RIVER VALLEY]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC OF RIVER VALLEY]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UMR]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UMR]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UMR]|[plan_HMO/PPO] standard_charge|[payer_UMR]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UMR]|[Plan_HMO/PPO] standard_charge|[payer_VA OPTUM]|[plan_VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA OPTUM]|[plan_VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_VA OPTUM]|[plan_VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_VA OPTUM]|[plan_VETERANS ADMIN] standard_charge|[payer_VA OPTUM]|[plan_VETERANS ADMIN] |methodology additional_payer_notes |[payer_VA OPTUM]|[Plan_VETERANS ADMIN] standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_WELLCARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_WELLCARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE]|[Plan_MANAGED MEDICARE] additional_generic_notes ROOM AND BOARD ADOL PSYCH 124 RC facility inpatient 1775 900 565 1571 650 per diem 1070 per diem 1030 per diem 1000 per diem other DRG 846 per diem 650 per diem 900 per diem 675 per diem other DRG other DRG 1023 per diem 700 per diem other DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem other DRG 900 per diem 1137 per diem other DRG 1571 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1241 per diem other DRG 850 per diem 1030 per diem 1100 per diem other DRG 1030 per diem 900 per diem 900 per diem 565 per diem other DRG 565 per diem other DRG 900 per diem 900 per diem 900 per diem 1086 per diem 900 per diem 1070 per diem 900 per diem 650 per diem 1070 per diem 900 per diem other DRG other DRG ROOM AND BOARD ADULT PSYCH 124 RC facility inpatient 1775 900 565 1571 650 per diem 1070 per diem 1030 per diem 1000 per diem other DRG 846 per diem 650 per diem 900 per diem 675 per diem other DRG other DRG 1023 per diem other DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem other DRG 900 per diem 1137 per diem other DRG 1571 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1241 per diem other DRG 850 per diem 1030 per diem 1100 per diem other DRG 1030 per diem 900 per diem 900 per diem 565 per diem other DRG 565 per diem other DRG 900 per diem 900 per diem 900 per diem 1086 per diem 900 per diem 1070 per diem 900 per diem 650 per diem 1070 per diem 900 per diem other DRG other DRG ROOM AND BOARD ADOL DETOX 126 RC facility inpatient 1775 900 565 1571 650 per diem 817 per diem 1030 per diem 1000 per diem other DRG 846 per diem 650 per diem 900 per diem 675 per diem other DRG other DRG 1023 per diem 700 per diem other DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem other DRG 900 per diem 1137 per diem other DRG 1571 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1241 per diem other DRG 850 per diem 1030 per diem 1100 per diem other DRG 1030 per diem 900 per diem 900 per diem 565 per diem other DRG 565 per diem other DRG 900 per diem 900 per diem 900 per diem 1086 per diem 900 per diem 845 per diem 900 per diem 650 per diem 845 per diem 900 per diem other DRG other DRG ROOM AND BOARD ADULT DETOX 126 RC facility inpatient 1775 900 565 1571 650 per diem 817 per diem 1030 per diem 1000 per diem other DRG 846 per diem 650 per diem 900 per diem 675 per diem other DRG other DRG 1023 per diem other DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem other DRG 900 per diem 1137 per diem other DRG 1571 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1241 per diem other DRG 850 per diem 1030 per diem 1100 per diem other DRG 1030 per diem 900 per diem 900 per diem 565 per diem other DRG 565 per diem other DRG 900 per diem 900 per diem 900 per diem 1086 per diem 900 per diem 845 per diem 900 per diem 650 per diem 845 per diem 900 per diem other DRG other DRG ROOM AND BOARD ADULT DETOX -A/G 126 RC facility inpatient 1775 900 565 1571 650 per diem 817 per diem 1030 per diem 1000 per diem other DRG 846 per diem 650 per diem 900 per diem 675 per diem other DRG other DRG 1023 per diem other DRG 1023 per diem 1023 per diem 1023 per diem 900 per diem 1023 per diem 650 per diem 650 per diem 950 per diem 650 per diem other DRG 900 per diem 1137 per diem other DRG 1571 per diem 650 per diem 794 per diem 1023 per diem 900 per diem 1100 per diem 1260 per diem 1100 per diem 900 per diem 1241 per diem other DRG 850 per diem 1030 per diem 1100 per diem other DRG 1030 per diem 900 per diem 900 per diem 565 per diem other DRG 565 per diem other DRG 900 per diem 900 per diem 900 per diem 1086 per diem 900 per diem 845 per diem 900 per diem 650 per diem 845 per diem 900 per diem other DRG other DRG INTENSIVE OUTPATIENT PROGRAM PSYCH - ADOL 905 RC facility outpatient 564 200 100 400 170 per diem 205 per diem 205 per diem 205 per diem 130 per diem 181 per diem 205 per diem 205 per diem 205 per diem 205 per diem 300 per diem 205 per diem 160 per diem 175 per diem 275 per diem 217 per diem 336 per diem 238 per diem 205 per diem 160 per diem 300 per diem 400 per diem 400 per diem 394 per diem 217 per diem 205 per diem 400 per diem 217 per diem 205 per diem 200 per diem 100 per diem 300 per diem 225 per diem 225 per diem 159 per diem 100 per diem 159 per diem 225 per diem 217 per diem 217 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH - ADULT 905 RC facility outpatient 564 200 100 400 170 per diem 205 per diem 205 per diem 205 per diem 130 per diem 181 per diem 205 per diem 205 per diem 205 per diem 205 per diem 300 per diem 205 per diem 160 per diem 175 per diem 275 per diem 217 per diem 336 per diem 238 per diem 205 per diem 160 per diem 300 per diem 400 per diem 400 per diem 394 per diem 217 per diem 205 per diem 400 per diem 217 per diem 205 per diem 200 per diem 100 per diem 300 per diem 225 per diem 225 per diem 159 per diem 100 per diem 159 per diem 225 per diem 217 per diem 217 per diem PARTIAL HOSPITAL PROGRAM PSYCH - ADOL 912 RC facility outpatient 795 250 143 600 350 per diem 415 per diem 430 per diem 430 per diem 260 per diem 185 per diem 143 per diem 430 per diem 430 per diem 430 per diem 430 per diem 350 per diem 430 per diem 175 per diem 175 per diem 450 per diem 238 per diem 476 per diem 238 per diem 430 per diem 175 per diem 350 per diem 560 per diem 600 per diem 551 per diem 238 per diem 415 per diem 600 per diem 238 per diem 415 per diem 250 per diem 150 per diem 350 per diem 400 per diem 238 per diem 400 per diem 265 per diem 165 per diem 265 per diem 400 per diem 238 per diem 238 per diem PARTIAL HOSPITAL PROGRAM PSYCH - ADULT 912 RC facility outpatient 795 250 143 600 350 per diem 415 per diem 430 per diem 430 per diem 260 per diem 185 per diem 143 per diem 430 per diem 430 per diem 430 per diem 430 per diem 350 per diem 430 per diem 175 per diem 175 per diem 450 per diem 238 per diem 476 per diem 238 per diem 430 per diem 175 per diem 350 per diem 560 per diem 600 per diem 551 per diem 238 per diem 415 per diem 600 per diem 238 per diem 415 per diem 250 per diem 150 per diem 350 per diem 400 per diem 238 per diem 400 per diem 265 per diem 165 per diem 265 per diem 400 per diem 238 per diem 238 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 1 915 RC facility outpatient 188 68 68 68 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 2 915 RC facility outpatient 188 68 68 68 per diem INTENSIVE OUTPATIENT PROGRAM PROCESS GROUP 3 915 RC facility outpatient 188 68 68 68 per diem Initial Hospital Care (30 Min) 99221 RC facility both 150 49 78 78 fee schedule 78 fee schedule 56 fee schedule 76 fee schedule 65 fee schedule 66 fee schedule 49 fee schedule 78 fee schedule 78 fee schedule Subseq Care (15 Min) 99231 RC facility both 90 20 72 72 fee schedule 30 fee schedule 40 fee schedule 34 fee schedule 32 fee schedule 33 fee schedule 47 fee schedule 40 fee schedule 20 fee schedule 47 fee schedule 27 fee schedule 47 fee schedule 40 fee schedule Subseq Care (25 Min) 99232 RC facility both 100 34 75 56 fee schedule 59 fee schedule 34 fee schedule 60 fee schedule 75 fee schedule 37 fee schedule 75 fee schedule 75 fee schedule 75 fee schedule Discharge Day Mgmt <30 Min 99238 RC facility both 150 37 76 37 fee schedule 76 fee schedule