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." Erlanger Behavioral Health 5/31/2024 2.0.0 "Chattanooga, Tennessee" 804 N. Holtzclaw Avenue license_ L000000033091 | 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_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 MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AETNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AETNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AETNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AETNA MANAGED MEDICARE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_AETNA MEDICARE SUPPLE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AETNA MEDICARE SUPPLE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AETNA MEDICARE SUPPLE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AETNA MEDICARE SUPPLE]|[plan_COMMERCIAL] standard_charge|[payer_AETNA MEDICARE SUPPLE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AETNA MEDICARE SUPPLE]|[Plan_COMMERCIAL] standard_charge|[payer_ALL SAVERS UNITED HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALL SAVERS UNITED HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALL SAVERS UNITED HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALL SAVERS UNITED HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_ALL SAVERS UNITED HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_ALL SAVERS UNITED HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLEGIANCE BENEFIT]|[plan_COMMERCIAL] standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_ALLEGIANCE BENEFIT]|[Plan_COMMERCIAL] standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_ALLEGIANCE BENEFIT]|[plan_HMO/PPO] standard_charge|[payer_ALLEGIANCE BENEFIT]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_ALLEGIANCE BENEFIT]|[Plan_HMO/PPO] standard_charge|[payer_ALLIANT HEALTH CARE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_ALLIANT HEALTH CARE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_ALLIANT HEALTH CARE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_ALLIANT HEALTH CARE]|[plan_COMMERCIAL] standard_charge|[payer_ALLIANT HEALTH CARE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_ALLIANT HEALTH CARE]|[Plan_COMMERCIAL] standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_AMBETTER]|[plan_COMMERCIAL] standard_charge|[payer_AMBETTER]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_AMBETTER]|[Plan_COMMERCIAL] standard_charge|[payer_AMERIVANTAGE MGD MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AMERIVANTAGE MGD MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_AMERIVANTAGE MGD MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_AMERIVANTAGE MGD MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_AMERIVANTAGE MGD MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_AMERIVANTAGE MGD MCR]|[Plan_MANAGED MEDICARE] 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_BCBS TENNESSEE]|[plan_BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS TENNESSEE]|[plan_BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS TENNESSEE]|[plan_BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS TENNESSEE]|[plan_BLUE CROSS] standard_charge|[payer_BCBS TENNESSEE]|[plan_BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS TENNESSEE]|[Plan_BLUE CROSS] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEACON HEALTH OPTIONS]|[plan_COMMERCIAL] standard_charge|[payer_BEACON HEALTH OPTIONS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BEACON HEALTH OPTIONS]|[Plan_COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS]|[Plan_COMMERCIAL] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO] standard_charge|[payer_BEHAVIORAL HEALTH SYSTEMS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_BEHAVIORAL HEALTH SYSTEMS]|[Plan_HMO/PPO] standard_charge|[payer_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_BLUECARE PLUS]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] standard_charge|[payer_BLUECARE PLUS]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUECARE PLUS]|[Plan_MANAGED MEDICARE] 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_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 MM]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CIGNA HEALTHSPRING MM]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CIGNA HEALTHSPRING MM]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CIGNA HEALTHSPRING MM]|[plan_MANAGED MEDICARE] standard_charge|[payer_CIGNA HEALTHSPRING MM]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CIGNA HEALTHSPRING MM]|[Plan_MANAGED MEDICARE] standard_charge|[payer_GEHA FEHB UHC]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GEHA FEHB UHC]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GEHA FEHB UHC]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GEHA FEHB UHC]|[plan_COMMERCIAL] standard_charge|[payer_GEHA FEHB UHC]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_GEHA FEHB UHC]|[Plan_COMMERCIAL] standard_charge|[payer_GOLDEN RULE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_GOLDEN RULE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_GOLDEN RULE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_GOLDEN RULE]|[plan_COMMERCIAL] standard_charge|[payer_GOLDEN RULE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_GOLDEN RULE]|[Plan_COMMERCIAL] standard_charge|[payer_HEALTH FIRST HEALTH PLANS]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH FIRST HEALTH PLANS]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTH FIRST HEALTH PLANS]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTH FIRST HEALTH PLANS]|[plan_HMO/PPO] standard_charge|[payer_HEALTH FIRST HEALTH PLANS]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTH FIRST HEALTH PLANS]|[Plan_HMO/PPO] standard_charge|[payer_HEALTH MANAGEMENT ADMIN]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH MANAGEMENT ADMIN]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTH MANAGEMENT ADMIN]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTH MANAGEMENT ADMIN]|[plan_HMO/PPO] standard_charge|[payer_HEALTH MANAGEMENT ADMIN]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HEALTH MANAGEMENT ADMIN]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HUMANA]|[plan_HMO/PPO] standard_charge|[payer_HUMANA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_HUMANA]|[Plan_HMO/PPO] standard_charge|[payer_HUMANA MGD MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MGD MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MGD MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MGD MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_HUMANA MGD MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MGD MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE]|negotiated_dollar standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_percentage standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |negotiated_algorithm estimated_amount|[payer_MEDICARE]|[plan_MEDICARE] standard_charge|[payer_MEDICARE]|[plan_MEDICARE] |methodology additional_payer_notes |[payer_MEDICARE]|[Plan_MEDICARE] standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MERITAIN]|[plan_COMMERCIAL] standard_charge|[payer_MERITAIN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_MERITAIN]|[Plan_COMMERCIAL] standard_charge|[payer_MOAA INSURANCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_MOAA INSURANCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_MOAA INSURANCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MOAA INSURANCE]|[plan_HMO/PPO] standard_charge|[payer_MOAA INSURANCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_MOAA INSURANCE]|[Plan_HMO/PPO] standard_charge|[payer_NETWORK 180]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_NETWORK 180]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_NETWORK 180]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_NETWORK 180]|[plan_COMMERCIAL] standard_charge|[payer_NETWORK 180]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_NETWORK 180]|[Plan_COMMERCIAL] standard_charge|[payer_NEW ERA LIFE INSRUANCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_NEW ERA LIFE INSRUANCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_NEW ERA LIFE INSRUANCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_NEW ERA LIFE INSRUANCE]|[plan_HMO/PPO] standard_charge|[payer_NEW ERA LIFE INSRUANCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_NEW ERA LIFE INSRUANCE]|[Plan_HMO/PPO] standard_charge|[payer_OPTUM BH]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_OPTUM BH]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_OPTUM BH]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_OPTUM BH]|[plan_HMO/PPO] standard_charge|[payer_OPTUM BH]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_OPTUM BH]|[Plan_HMO/PPO] standard_charge|[payer_PARAMOUNT INSURANCE]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_PARAMOUNT INSURANCE]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_PARAMOUNT INSURANCE]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PARAMOUNT INSURANCE]|[plan_HMO/PPO] standard_charge|[payer_PARAMOUNT INSURANCE]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_PARAMOUNT INSURANCE]|[Plan_HMO/PPO] standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PEACH STATE HEALTH PLAN]|[plan_COMMERCIAL] standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_PEACH STATE HEALTH PLAN]|[Plan_COMMERCIAL] standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_PEACH STATE HEALTH PLAN]|[plan_MANAGED MEDICAID] standard_charge|[payer_PEACH STATE HEALTH PLAN]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_PEACH STATE HEALTH PLAN]|[Plan_MANAGED MEDICAID] standard_charge|[payer_PERFORMCARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_PERFORMCARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_PERFORMCARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_PERFORMCARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_PERFORMCARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_PERFORMCARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_PHYSICIANS LIFE INSURANCE]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_PHYSICIANS LIFE INSURANCE]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PHYSICIANS LIFE INSURANCE]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PHYSICIANS LIFE INSURANCE]|[plan_COMMERCIAL] standard_charge|[payer_PHYSICIANS LIFE INSURANCE]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_PHYSICIANS LIFE INSURANCE]|[Plan_COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_PRIORITY HEALTH]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_PRIORITY HEALTH]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PRIORITY HEALTH]|[plan_COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_PRIORITY HEALTH]|[Plan_COMMERCIAL] standard_charge|[payer_SIGNATURE ADVANTAGE PLA]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SIGNATURE ADVANTAGE PLA]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SIGNATURE ADVANTAGE PLA]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SIGNATURE ADVANTAGE PLA]|[plan_MANAGED MEDICARE] standard_charge|[payer_SIGNATURE ADVANTAGE PLA]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SIGNATURE ADVANTAGE PLA]|[Plan_MANAGED MEDICARE] standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] standard_charge|[payer_STUDENT RESOURCES]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_STUDENT RESOURCES]|[Plan_COMMERCIAL] standard_charge|[payer_TNCARE AMERIGROUP]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TNCARE AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TNCARE AMERIGROUP]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TNCARE AMERIGROUP]|[plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE AMERIGROUP]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TNCARE AMERIGROUP]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE BLUE CARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TNCARE BLUE CARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TNCARE BLUE CARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TNCARE BLUE CARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE BLUE CARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TNCARE BLUE CARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE COVERKIDS BLUECARE]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TNCARE COVERKIDS BLUECARE]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TNCARE COVERKIDS BLUECARE]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TNCARE COVERKIDS BLUECARE]|[plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE COVERKIDS BLUECARE]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TNCARE COVERKIDS BLUECARE]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE UHC COMM]|[plan_MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_TNCARE UHC COMM]|[plan_MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_TNCARE UHC COMM]|[plan_MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_TNCARE UHC COMM]|[plan_MANAGED MEDICAID] standard_charge|[payer_TNCARE UHC COMM]|[plan_MANAGED MEDICAID] |methodology additional_payer_notes |[payer_TNCARE UHC COMM]|[Plan_MANAGED MEDICAID] standard_charge|[payer_TRICARE EAST]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE EAST]|[plan_TRICARE] standard_charge|[payer_TRICARE EAST]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE EAST]|[Plan_TRICARE] standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE OVERSEAS]|[plan_TRICARE] standard_charge|[payer_TRICARE OVERSEAS]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE OVERSEAS]|[Plan_TRICARE] standard_charge|[payer_TRICARE WEST]|[plan_TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE WEST]|[plan_TRICARE] standard_charge|[payer_TRICARE WEST]|[plan_TRICARE] |methodology additional_payer_notes |[payer_TRICARE WEST]|[Plan_TRICARE] standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_TRUSTMARK]|[plan_COMMERCIAL] standard_charge|[payer_TRUSTMARK]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_TRUSTMARK]|[Plan_COMMERCIAL] standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_TRUSTMARK]|[plan_HMO/PPO] standard_charge|[payer_TRUSTMARK]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_TRUSTMARK]|[Plan_HMO/PPO] standard_charge|[payer_UHC DUAL COMPLETE]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC DUAL COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC DUAL COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC DUAL COMPLETE]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC DUAL COMPLETE]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC DUAL COMPLETE]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHC MEDICARE SUPPLEMENT]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UHC MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UHC MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UHC MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] standard_charge|[payer_UHC MEDICARE SUPPLEMENT]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UHC MEDICARE SUPPLEMENT]|[Plan_COMMERCIAL] standard_charge|[payer_UHC MGD MCR]|[plan_MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UHC MGD MCR]|[plan_MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UHC MGD MCR]|[plan_MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UHC MGD MCR]|[plan_MANAGED MEDICARE] standard_charge|[payer_UHC MGD MCR]|[plan_MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UHC MGD MCR]|[Plan_MANAGED MEDICARE] standard_charge|[payer_UHIS UNITED HEALTH INTER]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_UHIS UNITED HEALTH INTER]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_UHIS UNITED HEALTH INTER]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UHIS UNITED HEALTH INTER]|[plan_HMO/PPO] standard_charge|[payer_UHIS UNITED HEALTH INTER]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_UHIS UNITED HEALTH INTER]|[Plan_HMO/PPO] standard_charge|[payer_UHSS UMR]|[plan_COMMERCIAL]|negotiated_dollar standard_charge|[payer_UHSS UMR]|[plan_COMMERCIAL] |negotiated_percentage standard_charge|[payer_UHSS UMR]|[plan_COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_UHSS UMR]|[plan_COMMERCIAL] standard_charge|[payer_UHSS UMR]|[plan_COMMERCIAL] |methodology additional_payer_notes |[payer_UHSS UMR]|[Plan_COMMERCIAL] 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 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_WEBTPA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_WEBTPA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_WEBTPA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_WEBTPA]|[plan_HMO/PPO] standard_charge|[payer_WEBTPA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_WEBTPA]|[Plan_HMO/PPO] additional_generic_notes ROOM AND BOARD ADULT PSYCH 124 RC facility inpatient 2106 845 575 1950 1190 per diem 1190 per diem 1250 per diem 1133 per diem 927 per diem 1125 per diem 1125 per diem 1125 per diem 950 per diem 1125 per diem 700 per diem 1133 per diem 1250 per diem 1250 per diem 1190 per diem 1020 per diem 1190 per diem 1190 per diem 675 per diem 1250 per diem 1250 per diem 1250 per diem 801 per diem 575 per diem 675 per diem 1133 per diem 1192 per diem 675 per diem 675 per diem 700 per diem 700 per diem 750 per diem 1086 per diem 1005 per diem 1005 per diem 1950 per diem 1250 per diem 1250 per diem 1250 per diem 1250 per diem 1190 per diem ROOM AND BOARD GERI PSYCH 124 RC facility inpatient 2106 845 575 1950 1190 per diem 1190 per diem 1250 per diem 1133 per diem 927 per diem 1125 per diem 1125 per diem 1125 per diem 950 per diem 1125 per diem 700 per diem 1133 per diem 1250 per diem 1250 per diem 1190 per diem 1020 per diem 1190 per diem 1190 per diem 675 per diem 1250 per diem 1250 per diem 1250 per diem 801 per diem 575 per diem 675 per diem 1133 per diem 1192 per diem 675 per diem 675 per diem 700 per diem 700 per diem 750 per diem 1086 per diem 1005 per diem 1005 per diem 1950 per diem 1250 per diem 1250 per diem 1250 per diem 1250 per diem 1190 per diem ROOM AND BOARD PSYCH ADULT UNIT 124 RC facility inpatient 2106 845 575 1950 1190 per diem 1190 per diem 1250 per diem 1133 per diem 927 per diem 1125 per diem 1125 per diem 1125 per diem 950 per diem 1125 per diem 700 per diem 1133 per diem 1250 per diem 1250 per diem 1190 per diem 1020 per diem 1190 per diem 1190 per diem 675 per diem 1250 per diem 1250 per diem 1250 per diem 801 per diem 575 per diem 675 per diem 1133 per diem 1192 per diem 675 per diem 675 per diem 700 per diem 700 per diem 750 per diem 1086 per diem 1005 per diem 1005 per diem 1950 per diem 1250 per diem 1250 per diem 1250 per diem 1250 per diem 1190 per diem ROOM AND BOARD PSYCH ADULT UNIT 124 RC facility inpatient 2106 845 575 1950 1190 per diem 1190 per diem 1250 per diem 1133 per diem 927 per diem 1125 per diem 1125 per diem 1125 per diem 950 per diem 1125 per diem 700 per diem 1133 per diem 1250 per diem 1250 per diem 1190 per diem 1020 per diem 1190 per diem 1190 per diem 675 per diem 1250 per diem 1250 per diem 1250 per diem 801 per diem 575 per diem 675 per diem 1133 per diem 1192 per diem 675 per diem 675 per diem 700 per diem 700 per diem 750 per diem 1086 per diem 1005 per diem 1005 per diem 1950 per diem 1250 per diem 1250 per diem 1250 per diem 1250 per diem 1190 per diem ROOM AND BOARD SUBSTANCE UNIT 126 RC facility inpatient 2106 845 700 1250 1190 per diem 1190 per diem 1250 per diem 1133 per diem 927 per diem 1125 per diem 1125 per diem 950 per diem 1125 per diem 700 per diem 1133 per diem 1250 per diem 1190 per diem 1020 per diem 1190 per diem 1250 per diem 1250 per diem 801 per diem 1133 per diem 960 per diem 700 per diem 700 per diem 750 per diem 1086 per diem 1250 per diem 1250 per diem 1250 per diem 1250 per diem 1190 per diem ROOM AND BOARD PSYCH ADolescent UNIT 124 RC facility inpatient 2106 845 750 1296 1190 per diem 1190 per diem 1133 per diem 927 per diem 1296 per diem 1296 per diem 950 per diem 750 per diem 750 per diem 750 per diem 750 per diem ELECTOCONVULSIVE THERAPY - INPATIENT ANC 901 RC facility inpatient 1200 600 300 1005 796 per diem 796 per diem 796 per diem 848 per diem 670 per diem 422 per diem 440 per diem 788 per diem 788 per diem 450 per diem 450 per diem 788 per diem 475 per diem 440 per diem 658 per diem 440 per diem 743 per diem 796 per diem 796 per diem 650 per diem 422 per diem 422 per diem 796 per diem 848 per diem 743 per diem 848 per diem 500 per diem 300 per diem 1005 per diem 375 per diem 475 per diem 470 per diem 440 per diem 796 per diem 714 per diem 848 per diem 832 per diem 848 per diem 743 per diem 848 per diem 848 per diem 796 per diem ELECTOCONVULSIVE THERAPY - OUTPATIENT 901 RC facility outpatient 1200 600 300 1005 796 per diem 796 per diem 796 per diem 743 per diem 670 per diem 422 per diem 440 per diem 788 per diem 788 per diem 450 per diem 450 per diem 788 per diem 475 per diem 440 per diem 658 per diem 440 per diem 743 per diem 796 per diem 796 per diem 650 per diem 422 per diem 422 per diem 796 per diem 848 per diem 743 per diem 848 per diem 500 per diem 300 per diem 1005 per diem 375 per diem 475 per diem 470 per diem 440 per diem 796 per diem 714 per diem 743 per diem 728 per diem 743 per diem 743 per diem 743 per diem 743 per diem 796 per diem INTENSIVE OUTPATIENT PROGRAM PROGRAM 905 RC facility outpatient 600 300 130 350 276 per diem 302 per diem 283 per diem 228 per diem 228 per diem 282 per diem 282 per diem 200 per diem 282 per diem 160 per diem 228 per diem 302 per diem 228 per diem 350 per diem 276 per diem 200 per diem 228 per diem 228 per diem 350 per diem 350 per diem 203 per diem 130 per diem 160 per diem 160 per diem 140 per diem 228 per diem 276 per diem 235 per diem 235 per diem 350 per diem 350 per diem 350 per diem 350 per diem PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC facility outpatient 900 450 242 583 583 per diem 489 per diem 464 per diem 550 per diem 550 per diem 550 per diem 242 per diem 489 per diem 557 per diem 583 per diem 525 per diem 557 per diem 557 per diem 364 per diem 260 per diem 242 per diem 242 per diem 260 per diem 469 per diem 583 per diem 468 per diem 468 per diem 557 per diem 557 per diem 557 per diem INTENSIVE OUTPATIENT PROGRAM GROUP 1 915 RC facility outpatient 200 235 302 276 per diem 235 per diem 302 per diem 235 per diem 235 per diem 235 per diem 235 per diem 235 per diem PARTIAL HOSPITAL PROGRAM PROCESS GROUP 1 915 RC facility outpatient 180 235 583 583 per diem 235 per diem 302 per diem 235 per diem 235 per diem 235 per diem 235 per diem 235 per diem Electroconvulsive therapy 90870 RC facility inpatient 210 84 62 165 165 fee schedule 150 fee schedule 115 fee schedule 120 fee schedule 120 fee schedule 120 fee schedule 94 fee schedule 150 fee schedule 165 fee schedule 165 fee schedule 100 fee schedule 80 fee schedule 165 fee schedule 165 fee schedule 165 fee schedule 150 fee schedule 82 fee schedule 62 fee schedule 95 fee schedule 165 fee schedule 165 fee schedule 165 fee schedule 165 fee schedule Initial Hospital Care 30 min 99221 RC facility inpatient 240 96 48 94 94 fee schedule 50 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule 60 fee schedule 94 fee schedule 65 fee schedule 59 fee schedule 94 fee schedule 74 fee schedule 60 fee schedule 60 fee schedule 66 fee schedule 66 fee schedule 66 fee schedule 66 fee schedule 48 fee schedule 48 fee schedule Initial Hospital Care 50 min 99222 RC facility inpatient 260 104 76 203 120 fee schedule 120 fee schedule 113 fee schedule 90 fee schedule 203 fee schedule 91 fee schedule 121 fee schedule 121 fee schedule 121 fee schedule 121 fee schedule 81 fee schedule 90 fee schedule 103 fee schedule 113 fee schedule 113 fee schedule 120 fee schedule 103 fee schedule 81 fee schedule 120 fee schedule 120 fee schedule 113 fee schedule 113 fee schedule 113 fee schedule 90 fee schedule 97 fee schedule 81 fee schedule 81 fee schedule 76 fee schedule 114 fee schedule 114 fee schedule 114 fee schedule 88 fee schedule 113 fee schedule 88 fee schedule 113 fee schedule 113 fee schedule 113 fee schedule 120 fee schedule Initial Hospital Care 70 min 99223 RC facility inpatient 280 112 81 219 219 fee schedule 219 fee schedule 173 fee schedule 119 fee schedule 175 fee schedule 131 fee schedule 104 fee schedule 104 fee schedule 104 fee schedule 104 fee schedule 99 fee schedule 119 fee schedule 161 fee schedule 173 fee schedule 173 fee schedule 219 fee schedule 161 fee schedule 127 fee schedule 219 fee schedule 219 fee schedule 173 fee schedule 173 fee schedule 173 fee schedule 119 fee schedule 152 fee schedule 99 fee schedule 99 fee schedule 81 fee schedule 124 fee schedule 124 fee schedule 124 fee schedule 101 fee schedule 173 fee schedule 101 fee schedule 173 fee schedule 173 fee schedule 173 fee schedule 219 fee schedule Subseq Care 15 min 99231 RC facility inpatient 140 56 29 71 71 fee schedule 71 fee schedule 39 fee schedule 29 fee schedule 45 fee schedule 32 fee schedule 53 fee schedule 53 fee schedule 53 fee schedule 53 fee schedule 30 fee schedule 29 fee schedule 32 fee schedule 39 fee schedule 39 fee schedule 71 fee schedule 39 fee schedule 29 fee schedule 71 fee schedule 71 fee schedule 39 fee schedule 39 fee schedule 39 fee schedule 29 fee schedule 31 fee schedule 30 fee schedule 30 fee schedule 32 fee schedule 40 fee schedule 40 fee schedule 40 fee schedule 34 fee schedule 39 fee schedule 34 fee schedule 39 fee schedule 39 fee schedule 39 fee schedule 71 fee schedule Subseq Care 25 min 99232 RC facility inpatient 160 64 32 94 74 fee schedule 32 fee schedule 94 fee schedule 54 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule 35 fee schedule 32 fee schedule 71 fee schedule 74 fee schedule 74 fee schedule 68 fee schedule 51 fee schedule 74 fee schedule 74 fee schedule 74 fee schedule 32 fee schedule 56 fee schedule 35 fee schedule 35 fee schedule 39 fee schedule 64 fee schedule 64 fee schedule 64 fee schedule 48 fee schedule 74 fee schedule 48 fee schedule 74 fee schedule 74 fee schedule 74 fee schedule Subseq Care 35 min 99233 RC facility inpatient 180 72 43 122 112 fee schedule 112 fee schedule 113 fee schedule 56 fee schedule 122 fee schedule 81 fee schedule 104 fee schedule 104 fee schedule 104 fee schedule 104 fee schedule 43 fee schedule 56 fee schedule 82 fee schedule 113 fee schedule 113 fee schedule 112 fee schedule 107 fee schedule 82 fee schedule 112 fee schedule 112 fee schedule 113 fee schedule 113 fee schedule 113 fee schedule 56 fee schedule 81 fee schedule 43 fee schedule 43 fee schedule 45 fee schedule 102 fee schedule 102 fee schedule 102 fee schedule 67 fee schedule 113 fee schedule 67 fee schedule 113 fee schedule 113 fee schedule 113 fee schedule 112 fee schedule Discharge Day Mgmt <30min 99238 RC facility inpatient 160 64 35 94 65 fee schedule 69 fee schedule 94 fee schedule 55 fee schedule 62 fee schedule 62 fee schedule 62 fee schedule 62 fee schedule 56 fee schedule 69 fee schedule 66 fee schedule 65 fee schedule 65 fee schedule 75 fee schedule 54 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule 69 fee schedule 56 fee schedule 56 fee schedule 56 fee schedule 35 fee schedule 71 fee schedule 71 fee schedule 71 fee schedule 85 fee schedule 65 fee schedule 85 fee schedule 65 fee schedule 65 fee schedule 65 fee schedule Discharge Day Mgmt >30min 99239 RC facility inpatient 160 64 21 126 116 fee schedule 116 fee schedule 79 fee schedule 100 fee schedule 126 fee schedule 95 fee schedule 82 fee schedule 82 fee schedule 82 fee schedule 82 fee schedule 56 fee schedule 100 fee schedule 79 fee schedule 79 fee schedule 116 fee schedule 103 fee schedule 68 fee schedule 116 fee schedule 116 fee schedule 79 fee schedule 79 fee schedule 79 fee schedule 100 fee schedule 83 fee schedule 56 fee schedule 56 fee schedule 21 fee schedule 92 fee schedule 92 fee schedule 92 fee schedule 89 fee schedule 79 fee schedule 89 fee schedule 79 fee schedule 79 fee schedule 79 fee schedule 116 fee schedule