hospital_name last_updated_on version hospital_location hospital_address license_number|CA "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." "Vista Behavioral Hospital, LLC" 12/31/2024 2.0.0 "Riverside, California" 5900 Brockton Avenue license_ 25000476 | CA 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 BEHAVIORAL HEALTH]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA BEHAVIORAL HEALTH]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_AETNA BEHAVIORAL HEALTH]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_AETNA BEHAVIORAL HEALTH]|[plan_ HMO/PPO] standard_charge|[payer_AETNA BEHAVIORAL HEALTH]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_AETNA BEHAVIORAL HEALTH]|[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_ALIGNMENT]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_ALIGNMENT]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_ALIGNMENT]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_ALIGNMENT]|[plan_ MANAGED MEDICARE] standard_charge|[payer_ALIGNMENT]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_ALIGNMENT]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS FEP]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS FEP]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS FEP]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS FEP]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS FEP]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS FEP]|[Plan_ BLUE CROSS] standard_charge|[payer_BCBS MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BCBS MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BCBS MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BCBS MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BCBS MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BCBS OOS]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BCBS OOS]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BCBS OOS]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BCBS OOS]|[plan_ BLUE CROSS] standard_charge|[payer_BCBS OOS]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BCBS OOS]|[Plan_ BLUE CROSS] standard_charge|[payer_BLUE SHIELD MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_BLUE SHIELD MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_BLUE SHIELD MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_BLUE SHIELD MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_BLUE SHIELD MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_BLUE SHIELD MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_BLUE SHIELD MHSA]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE SHIELD MHSA]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE SHIELD MHSA]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE SHIELD MHSA]|[plan_ BLUE CROSS] standard_charge|[payer_BLUE SHIELD MHSA]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE SHIELD MHSA]|[Plan_ BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_ BLUE CROSS] standard_charge|[payer_BLUE SHIELD OF CALIFORNIA]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_BLUE SHIELD OF CALIFORNIA]|[Plan_ BLUE CROSS] standard_charge|[payer_Brand New Day]|[plan_ Managed Medicare]|negotiated_dollar standard_charge|[payer_Brand New Day]|[plan_ Managed Medicare]|negotiated_percentage standard_charge|[payer_Brand New Day]|[plan_ Managed Medicare]|negotiated_algorithm estimated_amount|[payer_Brand New Day]|[plan_ Managed Medicare] standard_charge|[payer_Brand New Day]|[plan_ Managed Medicare]|methodology additional_payer_notes |[payer_Brand New Day]|[plan_ Managed Medicare] standard_charge|[payer_CARELON]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_CARELON]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_CARELON]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_CARELON]|[plan_ COMMERCIAL] standard_charge|[payer_CARELON]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_CARELON]|[Plan_ COMMERCIAL] standard_charge|[payer_CAREMORE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CAREMORE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CAREMORE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CAREMORE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CAREMORE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CAREMORE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_CENTRAL HEALTH PLAN OF CA]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_CENTRAL HEALTH PLAN OF CA]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_CENTRAL HEALTH PLAN OF CA]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_CENTRAL HEALTH PLAN OF CA]|[plan_ MANAGED MEDICARE] standard_charge|[payer_CENTRAL HEALTH PLAN OF CA]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_CENTRAL HEALTH PLAN OF CA]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_CHAMP VA]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_CHAMP VA]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_CHAMP VA]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_CHAMP VA]|[plan_ VETERANS ADMIN] standard_charge|[payer_CHAMP VA]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_CHAMP VA]|[Plan_ VETERANS ADMIN] standard_charge|[CHOICE PHYSICIAN]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[CHOICE PHYSICIAN]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[CHOICE PHYSICIAN]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[CHOICE PHYSICIAN]|[plan_ MANAGED MEDICARE] standard_charge|[CHOICE PHYSICIAN]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[CHOICE PHYSICIAN]|[plan_ MANAGED MEDICARE] 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_COMMERCIAL GENERIC]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_COMMERCIAL GENERIC]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_COMMERCIAL GENERIC]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_COMMERCIAL GENERIC]|[plan_ COMMERCIAL] standard_charge|[payer_COMMERCIAL GENERIC]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_COMMERCIAL GENERIC]|[Plan_ COMMERCIAL] standard_charge|[payer_DESERT OASIS COMMERICAL]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_DESERT OASIS COMMERICAL]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_DESERT OASIS COMMERICAL]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_DESERT OASIS COMMERICAL]|[plan_ HMO/PPO] standard_charge|[payer_DESERT OASIS COMMERICAL]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_DESERT OASIS COMMERICAL]|[Plan_ HMO/PPO] standard_charge|[payer_DESERT OASIS MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_DESERT OASIS MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_DESERT OASIS MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_DESERT OASIS MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_DESERT OASIS MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_DESERT OASIS MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_EPIC MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_EPIC MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_EPIC MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_EPIC MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_EPIC MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_EPIC MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_EXCLUSIVE CARE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_EXCLUSIVE CARE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_EXCLUSIVE CARE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_EXCLUSIVE CARE]|[plan_ HMO/PPO] standard_charge|[payer_EXCLUSIVE CARE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_EXCLUSIVE CARE]|[Plan_ HMO/PPO] standard_charge|[payer_FIRST HEALTH]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_FIRST HEALTH]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_FIRST HEALTH]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_FIRST HEALTH]|[plan_ HMO/PPO] standard_charge|[payer_FIRST HEALTH]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_FIRST HEALTH]|[Plan_ HMO/PPO] standard_charge|[payer_GAB WORKERS COMP]|[plan_ WORKERS COMP]|negotiated_dollar standard_charge|[payer_GAB WORKERS COMP]|[plan_ WORKERS COMP] |negotiated_percentage standard_charge|[payer_GAB WORKERS COMP]|[plan_ WORKERS COMP] |negotiated_algorithm estimated_amount|[payer_GAB WORKERS COMP]|[plan_ WORKERS COMP] standard_charge|[payer_GAB WORKERS COMP]|[plan_ WORKERS COMP] |methodology additional_payer_notes |[payer_GAB WORKERS COMP]|[Plan_ WORKERS COMP] 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_HEALTHNET PPO]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTHNET PPO]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HEALTHNET PPO]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HEALTHNET PPO]|[plan_ HMO/PPO] standard_charge|[payer_HEALTHNET PPO]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HEALTHNET PPO]|[Plan_ HMO/PPO] standard_charge|[payer_HEMET VALLEY GRP MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HEMET VALLEY GRP MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HEMET VALLEY GRP MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HEMET VALLEY GRP MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HEMET VALLEY GRP MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HEMET VALLEY GRP MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HMC HEALTHWORKS]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HMC HEALTHWORKS]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_HMC HEALTHWORKS]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_HMC HEALTHWORKS]|[plan_ HMO/PPO] standard_charge|[payer_HMC HEALTHWORKS]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_HMC HEALTHWORKS]|[Plan_ HMO/PPO] standard_charge|[payer_HMO OF CALIFORNIA]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HMO OF CALIFORNIA]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HMO OF CALIFORNIA]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HMO OF CALIFORNIA]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HMO OF CALIFORNIA]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HMO OF CALIFORNIA]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_HOLMAN GROUP]|[plan_ BLUE CROSS]|negotiated_dollar standard_charge|[payer_HOLMAN GROUP]|[plan_ BLUE CROSS] |negotiated_percentage standard_charge|[payer_HOLMAN GROUP]|[plan_ BLUE CROSS] |negotiated_algorithm estimated_amount|[payer_HOLMAN GROUP]|[plan_ BLUE CROSS] standard_charge|[payer_HOLMAN GROUP]|[plan_ BLUE CROSS] |methodology additional_payer_notes |[payer_HOLMAN GROUP]|[Plan_ BLUE CROSS] standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_HUMANA MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_IEHP COVERED CA]|[plan_HMO/PPO]|negotiated_dollar standard_charge|[payer_IEHP COVERED CA]|[plan_HMO/PPO] |negotiated_percentage standard_charge|[payer_IEHP COVERED CA]|[plan_HMO/PPO] |negotiated_algorithm estimated_amount|[payer_IEHP COVERED CA]|[plan_HMO/PPO] standard_charge|[payer_IEHP COVERED CA]|[plan_HMO/PPO] |methodology additional_payer_notes |[payer_IEHP COVERED CA]|[plan_HMO/PPO] standard_charge|[IEHP MCAL]|[plan_ MANAGED MEDICAID ]|negotiated_dollar standard_charge|[IEHP MCAL]|[plan_ MANAGED MEDICAID ]|negotiated_percentage standard_charge|[IEHP MCAL]|[plan_ MANAGED MEDICAID ] |negotiated_algorithm estimated_amount|[IEHP MCAL]|[plan_ MANAGED MEDICAID ] standard_charge|[IEHP MCAL]|[plan_ MANAGED MEDICAID ] |methodology additional_payer_notes |[IEHP MCAL]|[plan_ MANAGED MEDICAID ] standard_charge|[payer_IEHP MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_IEHP MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_IEHP MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_IEHP MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_IEHP MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_IEHP MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[IMPERIAL HEALTH HOLDINGS]|[plan_MANAGED MEDICARE ]|negotiated_dollar standard_charge|[IMPERIAL HEALTH HOLDINGS]|[plan_MANAGED MEDICARE ] |negotiated_percentage standard_charge| [IMPERIAL HEALTH HOLDINGS]|[plan_MANAGED MEDICARE ]|negotiated_algorithm estimated_amount|[IMPERIAL HEALTH HOLDINGS]|[plan_MANAGED MEDICARE ] standard_charge|[IMPERIAL HEALTH HOLDINGS]|[plan_MANAGED MEDICARE ] |methodology additional_payer_notes |[IMPERIAL HEALTH HOLDINGS]|[plan_MANAGED MEDICARE ] standard_charge|[payer_INDIAN HEALTH INC]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_INDIAN HEALTH INC]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_INDIAN HEALTH INC]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_INDIAN HEALTH INC]|[plan_ COMMERCIAL] standard_charge|[payer_INDIAN HEALTH INC]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_INDIAN HEALTH INC]|[Plan_ COMMERCIAL] standard_charge|[payer_INNOVAGE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_INNOVAGE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_INNOVAGE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_INNOVAGE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_INNOVAGE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_INNOVAGE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_INTER VALLEY MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_INTER VALLEY MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_INTER VALLEY MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_INTER VALLEY MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_INTER VALLEY MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_INTER VALLEY MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_INTERMOUNTAIN HEALTHCARE]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_INTERMOUNTAIN HEALTHCARE]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_INTERMOUNTAIN HEALTHCARE]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_INTERMOUNTAIN HEALTHCARE]|[plan_ COMMERCIAL] standard_charge|[payer_INTERMOUNTAIN HEALTHCARE]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_INTERMOUNTAIN HEALTHCARE]|[Plan_ COMMERCIAL] standard_charge|[KAISER SELF FUNDED]|[plan_HMO/PPO ]|negotiated_dollar standard_charge|[KAISER SELF FUNDED]|[plan_HMO/PPO ]|negotiated_percentage standard_charge|[KAISER SELF FUNDED]|[plan_HMO/PPO ] |negotiated_algorithm estimated_amount|[KAISER SELF FUNDED]|[plan_HMO/PPO ] standard_charge|[KAISER SELF FUNDED]|[plan_HMO/PPO ]|methodology additional_payer_notes |[KAISER SELF FUNDED]|[plan_HMO/PPO ] standard_charge|[payer_KAISER MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_KAISER MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_KAISER MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_KAISER MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_KAISER MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_KAISER MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_KAISER PERMANENTE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_KAISER PERMANENTE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_KAISER PERMANENTE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_KAISER PERMANENTE]|[plan_ HMO/PPO] standard_charge|[payer_KAISER PERMANENTE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_KAISER PERMANENTE]|[Plan_ HMO/PPO] standard_charge|[payer_LOMA LINDA RISK MGNMT]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_LOMA LINDA RISK MGNMT]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_LOMA LINDA RISK MGNMT]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_LOMA LINDA RISK MGNMT]|[plan_ COMMERCIAL] standard_charge|[payer_LOMA LINDA RISK MGNMT]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_LOMA LINDA RISK MGNMT]|[Plan_ COMMERCIAL] standard_charge|[payer_LOS ANGELES IMD EXCLUDED]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_LOS ANGELES IMD EXCLUDED]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_LOS ANGELES IMD EXCLUDED]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_LOS ANGELES IMD EXCLUDED]|[plan_ MANAGED MEDICAID] standard_charge|[payer_LOS ANGELES IMD EXCLUDED]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_LOS ANGELES IMD EXCLUDED]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_MEDI CAL RIVERSIDE]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_MEDI CAL RIVERSIDE]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_MEDI CAL RIVERSIDE]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDI CAL RIVERSIDE]|[plan_ MEDICAID] standard_charge|[payer_MEDI CAL RIVERSIDE]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_MEDI CAL RIVERSIDE]|[Plan_ MEDICAID] standard_charge|[payer_MEDI CAL SAN BERNARDINO]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_MEDI CAL SAN BERNARDINO]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_MEDI CAL SAN BERNARDINO]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDI CAL SAN BERNARDINO]|[plan_ MEDICAID] standard_charge|[payer_MEDI CAL SAN BERNARDINO]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_MEDI CAL SAN BERNARDINO]|[Plan_ MEDICAID] standard_charge|[payer_MEDI-CAL]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_MEDI-CAL]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_MEDI-CAL]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDI-CAL]|[plan_ MEDICAID] standard_charge|[payer_MEDI-CAL]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_MEDI-CAL]|[Plan_ MEDICAID] standard_charge|[payer_MEDICAL SHORT DOYLE]|[plan_ MEDICAID]|negotiated_dollar standard_charge|[payer_MEDICAL SHORT DOYLE]|[plan_ MEDICAID] |negotiated_percentage standard_charge|[payer_MEDICAL SHORT DOYLE]|[plan_ MEDICAID] |negotiated_algorithm estimated_amount|[payer_MEDICAL SHORT DOYLE]|[plan_ MEDICAID] standard_charge|[payer_MEDICAL SHORT DOYLE]|[plan_ MEDICAID] |methodology additional_payer_notes |[payer_MEDICAL SHORT DOYLE]|[Plan_ MEDICAID] 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_MHN]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MHN]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MHN]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MHN]|[plan_ HMO/PPO] standard_charge|[payer_MHN]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MHN]|[Plan_ HMO/PPO] standard_charge|[payer_MHN MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MHN MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MHN MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MHN MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MHN MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MHN MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MISC MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MANAGED MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MISC MANAGED MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MGD MEDICAID]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MGD MEDICAID]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MISC MGD MEDICAID]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MISC MGD MEDICAID]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MISC MGD MEDICAID]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes |[payer_MISC MGD MEDICAID]|[plan_ MANAGED MEDICAID] 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_MOLINA MARKETPLACE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] standard_charge|[payer_MOLINA MARKETPLACE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_MOLINA MARKETPLACE]|[Plan_ HMO/PPO] standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MOLINA MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_MOLINA MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_MULTIPLAN]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MULTIPLAN]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_MULTIPLAN]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_MULTIPLAN]|[plan_ COMMERCIAL] standard_charge|[payer_MULTIPLAN]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_MULTIPLAN]|[Plan_ COMMERCIAL] standard_charge|[payer_NEIGHBORHOOD HEALTH PACE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_NEIGHBORHOOD HEALTH PACE]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_NEIGHBORHOOD HEALTH PACE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_NEIGHBORHOOD HEALTH PACE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_NEIGHBORHOOD HEALTH PACE]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes |[payer_NEIGHBORHOOD HEALTH PACE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_ORANGE COUNTY]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_ORANGE COUNTY]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_ORANGE COUNTY]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_ORANGE COUNTY]|[plan_ MANAGED MEDICAID] standard_charge|[payer_ORANGE COUNTY]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes |[payer_ORANGE COUNTY]|[plan_ MANAGED MEDICAID] standard_charge|[payer_PRIME HEALTH MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_PRIME HEALTH MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_PRIME HEALTH MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_PRIME HEALTH MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_PRIME HEALTH MEDICARE]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes |[payer_PRIME HEALTH MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_PRIMECARE]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_PRIMECARE]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_PRIMECARE]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_PRIMECARE]|[plan_ HMO/PPO] standard_charge|[payer_PRIMECARE]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_PRIMECARE]|[Plan_ HMO/PPO] standard_charge|[payer_PRIMECARE MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_PRIMECARE MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_PRIMECARE MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_PRIMECARE MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_PRIMECARE MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_PRIMECARE MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_PROSPECT MEDICAL GROUP]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_PROSPECT MEDICAL GROUP]|[plan_ COMMERCIAL] |negotiated_percentage standard_charge|[payer_PROSPECT MEDICAL GROUP]|[plan_ COMMERCIAL] |negotiated_algorithm estimated_amount|[payer_PROSPECT MEDICAL GROUP]|[plan_ COMMERCIAL] standard_charge|[payer_PROSPECT MEDICAL GROUP]|[plan_ COMMERCIAL] |methodology additional_payer_notes |[payer_PROSPECT MEDICAL GROUP]|[Plan_ COMMERCIAL] standard_charge|[payer_REDLANDS COMMTY HOSPITAL]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_REDLANDS COMMTY HOSPITAL]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_REDLANDS COMMTY HOSPITAL]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_REDLANDS COMMTY HOSPITAL]|[plan_ HMO/PPO] standard_charge|[payer_REDLANDS COMMTY HOSPITAL]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_REDLANDS COMMTY HOSPITAL]|[Plan_ HMO/PPO] standard_charge|[payer_REGAL COMM]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_REGAL COMM]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_REGAL COMM]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_REGAL COMM]|[plan_ HMO/PPO] standard_charge|[payer_REGAL COMM]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_REGAL COMM]|[Plan_ HMO/PPO] standard_charge|[payer_REGAL/HERRITAGE MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_REGAL/HERRITAGE MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_REGAL/HERRITAGE MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_REGAL/HERRITAGE MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_REGAL/HERRITAGE MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_REGAL/HERRITAGE MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_RIVERSIDE DEPT MENTAL HL]|[plan_ LOCAL GOVT]|negotiated_dollar standard_charge|[payer_RIVERSIDE DEPT MENTAL HL]|[plan_ LOCAL GOVT] |negotiated_percentage standard_charge|[payer_RIVERSIDE DEPT MENTAL HL]|[plan_ LOCAL GOVT] |negotiated_algorithm estimated_amount|[payer_RIVERSIDE DEPT MENTAL HL]|[plan_ LOCAL GOVT] standard_charge|[payer_RIVERSIDE DEPT MENTAL HL]|[plan_ LOCAL GOVT] |methodology additional_payer_notes |[payer_RIVERSIDE DEPT MENTAL HL]|[Plan_ LOCAL GOVT] standard_charge|[payer_RIVERSIDE IMD EXCLUDE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_RIVERSIDE IMD EXCLUDE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_RIVERSIDE IMD EXCLUDE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_RIVERSIDE IMD EXCLUDE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_RIVERSIDE IMD EXCLUDE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_RIVERSIDE IMD EXCLUDE]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SAN BERNADINO IMD EXLUDE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN BERNADINO IMD EXLUDE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN BERNADINO IMD EXLUDE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN BERNADINO IMD EXLUDE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SAN BERNADINO IMD EXLUDE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN BERNADINO IMD EXLUDE]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SAN DIEGO IMD EXLUDE]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN DIEGO IMD EXLUDE]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN DIEGO IMD EXLUDE]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN DIEGO IMD EXLUDE]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SAN DIEGO IMD EXLUDE]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN DIEGO IMD EXLUDE]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SAN LUIS OBISPO IMD]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_SAN LUIS OBISPO IMD]|[plan_ MANAGED MEDICAID] |negotiated_percentage standard_charge|[payer_SAN LUIS OBISPO IMD]|[plan_ MANAGED MEDICAID] |negotiated_algorithm estimated_amount|[payer_SAN LUIS OBISPO IMD]|[plan_ MANAGED MEDICAID] standard_charge|[payer_SAN LUIS OBISPO IMD]|[plan_ MANAGED MEDICAID] |methodology additional_payer_notes |[payer_SAN LUIS OBISPO IMD]|[Plan_ MANAGED MEDICAID] standard_charge|[payer_SCAN HEALTH PLAN]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_SCAN HEALTH PLAN]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_SCAN HEALTH PLAN]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_SCAN HEALTH PLAN]|[plan_ MANAGED MEDICARE] standard_charge|[payer_SCAN HEALTH PLAN]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_SCAN HEALTH PLAN]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_ SELF PAY]|[plan_ SELF PAY]|negotiated_dollar standard_charge|[payer_ SELF PAY]|[plan_ SELF PAY]|negotiated_percentage standard_charge|[payer_ SELF PAY]|[plan_ SELF PAY]|negotiated_algorithm estimated_amount|[payer_ SELF PAY]|[plan_ SELF PAY] standard_charge|[payer_ SELF PAY]|[plan_ SELF PAY]|methodology additional_payer_notes |[payer_ SELF PAY]|[plan_ SELF PAY] standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] standard_charge|[payer_TRICARE FOR LIFE]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRICARE FOR LIFE]|[Plan_ TRICARE] standard_charge|[payer_TRIVALLEY MEDICAL GROUP]|[plan_ MANAGED MEDICARE ]|negotiated_dollar standard_charge|[payer_TRIVALLEY MEDICAL GROUP]|[plan_ MANAGED MEDICARE ] |negotiated_percentage standard_charge|[payer_TRIVALLEY MEDICAL GROUP]|[plan_ MANAGED MEDICARE ] |negotiated_algorithm estimated_amount|[payer_TRIVALLEY MEDICAL GROUP]|[plan_ MANAGED MEDICARE ] standard_charge|[payer_TRIVALLEY MEDICAL GROUP]|[plan_ MANAGED MEDICARE ]|methodology additional_payer_notes |[payer_TRIVALLEY MEDICAL GROUP]|[plan_ MANAGED MEDICARE ] standard_charge|[payer_TRIWEST]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRIWEST]|[plan_ TRICARE] |negotiated_percentage standard_charge|[payer_TRIWEST]|[plan_ TRICARE] |negotiated_algorithm estimated_amount|[payer_TRIWEST]|[plan_ TRICARE] standard_charge|[payer_TRIWEST]|[plan_ TRICARE] |methodology additional_payer_notes |[payer_TRIWEST]|[Plan_ TRICARE] standard_charge|[payer_TRIWEST VA CCN]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_TRIWEST VA CCN]|[plan_ VETERANS ADMIN] |negotiated_percentage standard_charge|[payer_TRIWEST VA CCN]|[plan_ VETERANS ADMIN] |negotiated_algorithm estimated_amount|[payer_TRIWEST VA CCN]|[plan_ VETERANS ADMIN] standard_charge|[payer_TRIWEST VA CCN]|[plan_ VETERANS ADMIN] |methodology additional_payer_notes |[payer_TRIWEST VA CCN]|[Plan_ VETERANS ADMIN] standard_charge|[payer_UBH MEDICARE]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_UBH MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_percentage standard_charge|[payer_UBH MEDICARE]|[plan_ MANAGED MEDICARE] |negotiated_algorithm estimated_amount|[payer_UBH MEDICARE]|[plan_ MANAGED MEDICARE] standard_charge|[payer_UBH MEDICARE]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_UBH MEDICARE]|[Plan_ MANAGED MEDICARE] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_ HMO/PPO] |negotiated_percentage standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_ HMO/PPO] |negotiated_algorithm estimated_amount|[payer_UNITED BEHAVIORAL HEALTH]|[plan_ HMO/PPO] standard_charge|[payer_UNITED BEHAVIORAL HEALTH]|[plan_ HMO/PPO] |methodology additional_payer_notes |[payer_UNITED BEHAVIORAL HEALTH]|[Plan_ HMO/PPO] standard_charge|[payer_WELLCARE BY HEALTH NET]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE BY HEALTH NET]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_WELLCARE BY HEALTH NET]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_WELLCARE BY HEALTH NET]|[plan_ MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY HEALTH NET]|[plan_ MANAGED MEDICARE] |methodology additional_payer_notes |[payer_WELLCARE BY HEALTH NET]|[plan_ MANAGED MEDICARE] standard_charge|[payer_WORKMANS COMP GENERIC]|[plan_ WORKERS COMP]|negotiated_dollar standard_charge|[payer_WORKMANS COMP GENERIC]|[plan_ WORKERS COMP] |negotiated_percentage standard_charge|[payer_WORKMANS COMP GENERIC]|[plan_ WORKERS COMP] |negotiated_algorithm estimated_amount|[payer_WORKMANS COMP GENERIC]|[plan_ WORKERS COMP] standard_charge|[payer_WORKMANS COMP GENERIC]|[plan_ WORKERS COMP] |methodology additional_payer_notes |[payer_WORKMANS COMP GENERIC]|[Plan_ WORKERS COMP] additional_generic_notes ROOM AND BOARD ADULT PSYCH 124 RC facility Inpatient 2495 850 781 2495 1027 per diem 1027 per diem per diem 1000 per diem 1000 per diem 1000 per diem 1000 per diem per diem 1133 per diem 1121 per diem 1034 per diem 1583 per diem 1119 per diem 2495 per diem 993 per diem 1097 per diem 1027 per diem 2495 per diem 1027 per diem 900 per diem 1200 per diem 1034 per diem 1102 per diem 975 per diem 975 per diem 1200 per diem 2495 per diem 1002 per diem 1032 per diem 1032 per diem 1110 per diem 1272 per diem 1097 per diem 847 per diem 1097 per diem Per DRG 1135 per diem Per DRG 1097 per diem 2495 per diem 1500 per diem 1097 per diem 1043 per diem 1043 per diem 950 per diem 993 per diem 1272 per diem 1272 per diem 1097 per diem 1097 per diem 1097 per diem 850 per diem 781 per diem 814 per diem Per DRG 1100 per diem 2495 per diem ROOM AND BOARD ADULT DETOX 126 RC facility Inpatient 2495 850 781 2495 1027 per diem 1027 per diem per diem 1000 per diem 1000 per diem 1000 per diem 1000 per diem per diem 1133 per diem 1121 per diem 1034 per diem 1583 per diem 1119 per diem 2495 per diem 993 per diem 1097 per diem 1027 per diem 2495 per diem 1027 per diem 900 per diem 1200 per diem 1034 per diem 992 per diem 975 per diem 975 per diem 1200 per diem 2495 per diem 1002 per diem 1032 per diem 1032 per diem Per DRG 1135 per diem 1097 per diem 2495 per diem 850 per diem 1500 per diem 1097 per diem 1043 per diem 1043 per diem 950 per diem 993 per diem 850 per diem 781 per diem 781 per diem Per DRG 1100 per diem 2495 per diem ROOM AND BOARD ADULT CD REHAB 128 RC facility Inpatient 2495 850 750 2495 per diem 912 per diem 913 per diem 750 per diem 1583 per diem 1017 per diem 2495 per diem 909 per diem 1027 per diem 2495 per diem 1027 per diem 750 per diem 950 per diem 750 per diem 950 per diem 905 per diem 1200 per diem 910 per diem 910 per diem 909 per diem 850 per diem 781 per diem 781 per diem 1100 per diem 2495 per diem INTENSIVE OUTPATIENT PROGRAM PSYCH ADULT PGM 905 RC facility Outpatient 571 350 182 571 288 per diem 288 per diem 328 per diem 226 per diem 226 per diem 226 per diem 226 per diem 328 per diem 310 per diem 327 per diem 260 per diem 325 per diem 571 per diem 328 per diem 328 per diem 182 per diem 297 per diem 571 per diem 244 per diem 328 per diem 182 per diem 288 per diem 571 per diem 288 per diem 300 per diem 328 per diem 350 per diem 260 per diem 302 per diem 328 per diem 237 per diem 237 per diem 237 per diem 328 per diem 400 per diem 300 per diem 328 per diem 571 per diem 224 per diem 224 per diem 182 per diem 328 per diem 378 per diem 328 per diem 571 per diem 328 per diem 328 per diem 350 per diem 328 per diem 328 per diem 300 per diem 300 per diem 200 per diem 182 per diem 244 per diem 328 per diem 312 per diem 350 per diem 328 per diem 182 per diem 328 per diem 182 per diem 239 per diem 247 per diem 182 per diem 571 per diem TELEHEALTH INTENSIVE OUTPATIENT PROGRAM PSYCH 905 RC facility Outpatient 571 350 182 571 288 per diem 288 per diem 328 per diem 226 per diem 226 per diem 226 per diem 226 per diem 328 per diem 310 per diem 327 per diem 260 per diem 325 per diem 571 per diem 328 per diem 328 per diem 182 per diem 297 per diem 571 per diem 244 per diem 328 per diem 182 per diem 288 per diem 571 per diem 288 per diem 300 per diem 328 per diem 350 per diem 260 per diem 302 per diem 328 per diem 237 per diem 237 per diem 237 per diem 328 per diem 400 per diem 300 per diem 328 per diem 571 per diem 224 per diem 224 per diem 182 per diem 328 per diem 378 per diem 328 per diem 571 per diem 328 per diem 328 per diem 350 per diem 328 per diem 328 per diem 300 per diem 300 per diem 200 per diem 182 per diem 244 per diem 328 per diem 312 per diem 350 per diem 328 per diem 182 per diem 328 per diem 182 per diem 239 per diem 247 per diem 182 per diem 571 per diem INTENSIVE OUTPATIENT PROGRAM CD ADULT PGM 906 RC facility Outpatient 571 350 182 571 288 per diem 288 per diem 328 per diem 226 per diem 226 per diem 226 per diem 226 per diem 328 per diem 310 per diem 327 per diem 260 per diem 325 per diem 571 per diem 328 per diem 328 per diem 182 per diem 297 per diem 571 per diem 244 per diem 328 per diem 182 per diem 288 per diem 571 per diem 288 per diem 300 per diem 328 per diem 350 per diem 260 per diem 302 per diem 328 per diem 328 per diem 400 per diem 300 per diem 328 per diem 571 per diem 224 per diem 224 per diem 182 per diem 328 per diem 378 per diem 328 per diem 571 per diem 328 per diem 328 per diem 350 per diem 328 per diem 328 per diem 300 per diem 300 per diem 200 per diem 182 per diem 244 per diem 328 per diem 312 per diem 350 per diem 328 per diem 182 per diem 328 per diem 182 per diem 239 per diem 247 per diem 182 per diem 571 per diem TELEHEALTH INTENSIVE OUTPATIENT PROGRAM CD 906 RC facility Outpatient 571 350 182 571 288 per diem 288 per diem 328 per diem 226 per diem 226 per diem 226 per diem 226 per diem 328 per diem 310 per diem 327 per diem 260 per diem 325 per diem 571 per diem 328 per diem 328 per diem 182 per diem 297 per diem 571 per diem 244 per diem 328 per diem 182 per diem 288 per diem 571 per diem 288 per diem 300 per diem 328 per diem 350 per diem 260 per diem 302 per diem 328 per diem 328 per diem 400 per diem 300 per diem 328 per diem 571 per diem 224 per diem 224 per diem 182 per diem 328 per diem 378 per diem 328 per diem 571 per diem 328 per diem 328 per diem 350 per diem 328 per diem 328 per diem 300 per diem 300 per diem 200 per diem 182 per diem 244 per diem 328 per diem 312 per diem 350 per diem 328 per diem 182 per diem 328 per diem 182 per diem 239 per diem 247 per diem 182 per diem 571 per diem CD PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC facility Outpatient 860 500 275 860 515 per diem 515 per diem 461 per diem 450 per diem 450 per diem 450 per diem 450 per diem 461 per diem 504 per diem 548 per diem 410 per diem 450 per diem 860 per diem 461 per diem 461 per diem 303 per diem 493 per diem 860 per diem 409 per diem 461 per diem 303 per diem 515 per diem 860 per diem 515 per diem 400 per diem 461 per diem 570 per diem 410 per diem 522 per diem 461 per diem 309 per diem 420 per diem 420 per diem 461 per diem 500 per diem 400 per diem 461 per diem 860 per diem 347 per diem 357 per diem 357 per diem 303 per diem 461 per diem 449 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 275 per diem 368 per diem 409 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 461 per diem 303 per diem 439 per diem 453 per diem 860 per diem PARTIAL HOSPITAL PROGRAM CD ADULT PGM 912 RC facility Outpatient 860 500 275 860 515 per diem 515 per diem 461 per diem 450 per diem 450 per diem 450 per diem 450 per diem 461 per diem 504 per diem 548 per diem 410 per diem 450 per diem 860 per diem 461 per diem 461 per diem 303 per diem 493 per diem 860 per diem 409 per diem 461 per diem 303 per diem 515 per diem 860 per diem 515 per diem 400 per diem 461 per diem 570 per diem 410 per diem 522 per diem 461 per diem 309 per diem 420 per diem 420 per diem 461 per diem 500 per diem 400 per diem 461 per diem 860 per diem 347 per diem 357 per diem 357 per diem 303 per diem 461 per diem 449 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 275 per diem 368 per diem 409 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 461 per diem 303 per diem 439 per diem 453 per diem 860 per diem PARTIAL HOSPITAL PROGRAM PSYCH ADULT PGM 912 RC facility Outpatient 860 500 275 860 515 per diem 515 per diem 461 per diem 450 per diem 450 per diem 450 per diem 450 per diem 461 per diem 504 per diem 548 per diem 410 per diem 450 per diem 860 per diem 461 per diem 461 per diem 303 per diem 493 per diem 860 per diem 409 per diem 461 per diem 303 per diem 515 per diem 860 per diem 515 per diem 400 per diem 461 per diem 570 per diem 410 per diem 522 per diem 461 per diem 309 per diem 420 per diem 420 per diem 461 per diem 500 per diem 400 per diem 461 per diem 860 per diem 347 per diem 357 per diem 357 per diem 303 per diem 461 per diem 449 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 275 per diem 368 per diem 409 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 461 per diem 303 per diem 439 per diem 453 per diem 860 per diem PYSCH PARTIAL HOSPITAL PROGRAM PROGRAM 912 RC facility Outpatient 860 500 275 860 515 per diem 515 per diem 461 per diem 450 per diem 450 per diem 450 per diem 450 per diem 461 per diem 504 per diem 548 per diem 410 per diem 450 per diem 860 per diem 461 per diem 461 per diem 303 per diem 493 per diem 860 per diem 409 per diem 461 per diem 303 per diem 515 per diem 860 per diem 515 per diem 400 per diem 461 per diem 570 per diem 410 per diem 522 per diem 461 per diem 309 per diem 420 per diem 420 per diem 461 per diem 500 per diem 400 per diem 461 per diem 860 per diem 347 per diem 357 per diem 357 per diem 303 per diem 461 per diem 449 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 275 per diem 368 per diem 409 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 461 per diem 303 per diem 439 per diem 453 per diem 860 per diem TELEHEALTH PARTIAL HOSPITAL PROGRAM CD 912 RC facility Outpatient 860 500 275 860 515 per diem 515 per diem 461 per diem 450 per diem 450 per diem 450 per diem 450 per diem 461 per diem 504 per diem 548 per diem 410 per diem 450 per diem 860 per diem 461 per diem 461 per diem 303 per diem 493 per diem 860 per diem 409 per diem 461 per diem 303 per diem 515 per diem 860 per diem 515 per diem 400 per diem 461 per diem 570 per diem 410 per diem 522 per diem 461 per diem 309 per diem 420 per diem 420 per diem 461 per diem 500 per diem 400 per diem 461 per diem 860 per diem 347 per diem 357 per diem 357 per diem 303 per diem 461 per diem 449 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 275 per diem 368 per diem 409 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 461 per diem 303 per diem 439 per diem 453 per diem 860 per diem TELEHEALTH PARTIAL HOSPITAL PROGRAM PSYCH 912 RC facility Outpatient 860 500 275 860 515 per diem 515 per diem 461 per diem 450 per diem 450 per diem 450 per diem 450 per diem 461 per diem 504 per diem 548 per diem 410 per diem 450 per diem 860 per diem 461 per diem 461 per diem 303 per diem 493 per diem 860 per diem 409 per diem 461 per diem 303 per diem 515 per diem 860 per diem 515 per diem 400 per diem 461 per diem 570 per diem 410 per diem 522 per diem 461 per diem 309 per diem 420 per diem 420 per diem 461 per diem 500 per diem 400 per diem 461 per diem 860 per diem 347 per diem 357 per diem 357 per diem 303 per diem 461 per diem 449 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 275 per diem 368 per diem 409 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 461 per diem 303 per diem 439 per diem 453 per diem 860 per diem INTENSIVE OUTPATIENT PROGRAM MCR CD PROC 1 915 RC facility Outpatient 191 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 500 per diem 461 per diem 303 per diem 239 per diem 303 per diem INTENSIVE OUTPATIENT PROGRAM MCR PSC PROC 1 915 RC facility Outpatient 191 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem MCR PARTIAL HOSPITAL PROGRAM PSY PG 3 915 RC facility Outpatient 223 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem PARTIAL HOSPITAL PROGRAM MCR CD PG 3 915 RC facility Outpatient 223 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem PROCESS GROUP 1 CD 915 RC facility Outpatient 224 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem TH INTENSIVE OUTPATIENT PROGRAM MCR/T MH PRC 915 RC facility Outpatient 191 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem TH INTENSIVE OUTPATIENT PROGRAM MH MCR/T PGP2 915 RC facility Outpatient 190 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem TH MCR PARTIAL HOSPITAL PROGRAM CD PG 3 915 RC facility Outpatient 223 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem TH PARTIAL HOSPITAL PROGRAM CD MC PROC 1 915 RC facility Outpatient 224 239 860 515 per diem 450 per diem 461 per diem 860 per diem 461 per diem 461 per diem 303 per diem 860 per diem 461 per diem 303 per diem 461 per diem 461 per diem 309 per diem 461 per diem 400 per diem 461 per diem 461 per diem 461 per diem 860 per diem 461 per diem 461 per diem 550 per diem 461 per diem 461 per diem 482 per diem 482 per diem 303 per diem 244 per diem 461 per diem 438 per diem 461 per diem 303 per diem 239 per diem 303 per diem