hospital_name	last_updated_on	version	hospital_location	hospital_address	license_number|MA	"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."																																																																																																																																																																																																																																																						
Haverhill Pavilion Behavioral Health	5/31/2024	2.0.0	"Haverhill, Massachusetts"	76 Summer Street	license_ 1189 | MA	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 MCARE COMPLETE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_AARP MCARE COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_AARP MCARE COMPLETE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_AARP MCARE COMPLETE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_AARP MCARE COMPLETE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_AARP MCARE COMPLETE]|[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 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_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 MCARE ADVANTAGE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_BCBS MCARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_BCBS MCARE ADVANTAGE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_BCBS MCARE ADVANTAGE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_BCBS MCARE ADVANTAGE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_BCBS MCARE ADVANTAGE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_BCBS OF MA]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_BCBS OF MA]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_BCBS OF MA]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_BCBS OF MA]|[plan_BLUE CROSS] 	standard_charge|[payer_BCBS OF MA]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_BCBS OF MA]|[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 MEDICAID]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_BEACON HEALTH MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_BEACON HEALTH MEDICAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_BEACON HEALTH MEDICAID]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_BEACON HEALTH MEDICAID]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_BEACON HEALTH MEDICAID]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] 	standard_charge|[payer_BEACON HEALTH STRATEGIES]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_BEACON HEALTH STRATEGIES]|[Plan_HMO/PPO]	standard_charge|[payer_BEACON SENIOR WHOLE HEALT]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_BEACON SENIOR WHOLE HEALT]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_BEACON SENIOR WHOLE HEALT]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_BEACON SENIOR WHOLE HEALT]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_BEACON SENIOR WHOLE HEALT]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_BEACON SENIOR WHOLE HEALT]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_BLUE BENEFITS]|[plan_BLUE CROSS]|negotiated_dollar	standard_charge|[payer_BLUE BENEFITS]|[plan_BLUE CROSS] |negotiated_percentage	standard_charge|[payer_BLUE BENEFITS]|[plan_BLUE CROSS] |negotiated_algorithm	estimated_amount|[payer_BLUE BENEFITS]|[plan_BLUE CROSS] 	standard_charge|[payer_BLUE BENEFITS]|[plan_BLUE CROSS] |methodology	additional_payer_notes |[payer_BLUE BENEFITS]|[Plan_BLUE CROSS]	standard_charge|[payer_CDPHP]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_CDPHP]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_CDPHP]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_CDPHP]|[plan_HMO/PPO] 	standard_charge|[payer_CDPHP]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_CDPHP]|[Plan_HMO/PPO]	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 MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_CIGNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_CIGNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_CIGNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_CIGNA MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_CIGNA MANAGED MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_COMMONWEALTH CARE ALLIANC]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_COMMONWEALTH CARE ALLIANC]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_ELEMENT CARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_ELEMENT CARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_ELEMENT CARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_ELEMENT CARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_ELEMENT CARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_ELEMENT CARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_FALLON MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_FALLON MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_FALLON MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_FALLON MANAGED MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_FALLON MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_FALLON MANAGED MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_GIC UNICARE]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_GIC UNICARE]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_GIC UNICARE]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_GIC UNICARE]|[plan_HMO/PPO] 	standard_charge|[payer_GIC UNICARE]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_GIC UNICARE]|[Plan_HMO/PPO]	"standard_charge|[payer_HEALTH PLANS, INC]|[plan_HMO/PPO]|negotiated_dollar"	"standard_charge|[payer_HEALTH PLANS, INC]|[plan_HMO/PPO] |negotiated_percentage"	"standard_charge|[payer_HEALTH PLANS, INC]|[plan_HMO/PPO] |negotiated_algorithm"	"estimated_amount|[payer_HEALTH PLANS, INC]|[plan_HMO/PPO] "	"standard_charge|[payer_HEALTH PLANS, INC]|[plan_HMO/PPO] |methodology"	"additional_payer_notes |[payer_HEALTH PLANS, INC]|[Plan_HMO/PPO]"	standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_HUMANA]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_HUMANA]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_HUMANA]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_MASS HEALTH MEDICAID]|[plan_MEDICAID ]|negotiated_dollar	standard_charge|[payer_MASS HEALTH MEDICAID]|[plan_MEDICAID ] |negotiated_percentage	standard_charge|[payer_MASS HEALTH MEDICAID]|[plan_MEDICAID ] |negotiated_algorithm	estimated_amount|[payer_MASS HEALTH MEDICAID]|[plan_MEDICAID ] 	standard_charge|[payer_MASS HEALTH MEDICAID]|[plan_MEDICAID ] |methodology	additional_payer_notes |[payer_MASS HEALTH MEDICAID]|[Plan_MEDICAID ]	standard_charge|[payer_MBHP]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_MBHP]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_MBHP]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_MBHP]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_MBHP]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_MBHP]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_MEDICAID PENDING]|[plan_MEDICAID ]|negotiated_dollar	standard_charge|[payer_MEDICAID PENDING]|[plan_MEDICAID ] |negotiated_percentage	standard_charge|[payer_MEDICAID PENDING]|[plan_MEDICAID ] |negotiated_algorithm	estimated_amount|[payer_MEDICAID PENDING]|[plan_MEDICAID ] 	standard_charge|[payer_MEDICAID PENDING]|[plan_MEDICAID ] |methodology	additional_payer_notes |[payer_MEDICAID PENDING]|[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_MODERN ASSISTANCE PLAN]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_MODERN ASSISTANCE PLAN]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_MODERN ASSISTANCE PLAN]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_MODERN ASSISTANCE PLAN]|[plan_HMO/PPO] 	standard_charge|[payer_MODERN ASSISTANCE PLAN]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_MODERN ASSISTANCE PLAN]|[Plan_HMO/PPO]	standard_charge|[payer_OXFORD HEALTH]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_OXFORD HEALTH]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_OXFORD HEALTH]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_OXFORD HEALTH]|[plan_HMO/PPO] 	standard_charge|[payer_OXFORD HEALTH]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_OXFORD HEALTH]|[Plan_HMO/PPO]	standard_charge|[payer_PACE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_PACE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_PACE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_PACE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_PACE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_PACE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_SENIOR WHOLE HEALTH MA]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_SENIOR WHOLE HEALTH MA]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_SENIOR WHOLE HEALTH MA]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_SENIOR WHOLE HEALTH MA]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_SENIOR WHOLE HEALTH MA]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_SENIOR WHOLE HEALTH MA]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_TRICARE FOR LIFE]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_TRICARE FOR LIFE]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_TRICARE FOR LIFE]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_TRICARE FOR LIFE]|[plan_HMO/PPO] 	standard_charge|[payer_TRICARE FOR LIFE]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_TRICARE FOR LIFE]|[Plan_HMO/PPO]	standard_charge|[payer_TUFTS]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_TUFTS]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_TUFTS]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_TUFTS]|[plan_HMO/PPO] 	standard_charge|[payer_TUFTS]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_TUFTS]|[Plan_HMO/PPO]	standard_charge|[payer_TUFTS HEALTH DIRECT]|[plan_HMO/PPO]|negotiated_dollar	standard_charge|[payer_TUFTS HEALTH DIRECT]|[plan_HMO/PPO] |negotiated_percentage	standard_charge|[payer_TUFTS HEALTH DIRECT]|[plan_HMO/PPO] |negotiated_algorithm	estimated_amount|[payer_TUFTS HEALTH DIRECT]|[plan_HMO/PPO] 	standard_charge|[payer_TUFTS HEALTH DIRECT]|[plan_HMO/PPO] |methodology	additional_payer_notes |[payer_TUFTS HEALTH DIRECT]|[Plan_HMO/PPO]	standard_charge|[payer_TUFTS MANAGED MEDICARE]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_TUFTS MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_TUFTS MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_TUFTS MANAGED MEDICARE]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_TUFTS MANAGED MEDICARE]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_TUFTS MANAGED MEDICARE]|[Plan_MANAGED MEDICARE]	standard_charge|[payer_TUFTS MGD MCAID]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_TUFTS MGD MCAID]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_TUFTS MGD MCAID]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_TUFTS MGD MCAID]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_TUFTS MGD MCAID]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_TUFTS MGD MCAID]|[Plan_MANAGED MEDICAID]	standard_charge|[payer_TUFTS UNIFY]|[plan_MANAGED MEDICARE]|negotiated_dollar	standard_charge|[payer_TUFTS UNIFY]|[plan_MANAGED MEDICARE] |negotiated_percentage	standard_charge|[payer_TUFTS UNIFY]|[plan_MANAGED MEDICARE] |negotiated_algorithm	estimated_amount|[payer_TUFTS UNIFY]|[plan_MANAGED MEDICARE] 	standard_charge|[payer_TUFTS UNIFY]|[plan_MANAGED MEDICARE] |methodology	additional_payer_notes |[payer_TUFTS UNIFY]|[Plan_MANAGED MEDICARE]	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]|[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_UBH MY CARE FAMILY MGD MD]|[plan_MANAGED MEDICAID]|negotiated_dollar	standard_charge|[payer_UBH MY CARE FAMILY MGD MD]|[plan_MANAGED MEDICAID] |negotiated_percentage	standard_charge|[payer_UBH MY CARE FAMILY MGD MD]|[plan_MANAGED MEDICAID] |negotiated_algorithm	estimated_amount|[payer_UBH MY CARE FAMILY MGD MD]|[plan_MANAGED MEDICAID] 	standard_charge|[payer_UBH MY CARE FAMILY MGD MD]|[plan_MANAGED MEDICAID] |methodology	additional_payer_notes |[payer_UBH MY CARE FAMILY MGD MD]|[Plan_MANAGED MEDICAID]	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_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 & BOARD ADULT PSYCH - WE	124	RC	facility	inpatient				1400	1000	840	1209					other	DRG	1065				per diem		1065				per diem		1058				per diem		1058				per diem		1058				per diem		1058				per diem		974				per diem		1091				per diem		974				per diem		1058				per diem		840				per diem						other	DRG	1152				per diem						other	DRG					other	DRG					other	DRG	974				per diem		974				per diem		1065				per diem						other	DRG	955				per diem		955				per diem		955				per diem						other	DRG	995				per diem		882				per diem						other	DRG	1202				per diem		1209				per diem		1079				per diem		955				per diem		1079				per diem		955				per diem						other	DRG	1065				per diem						other	DRG	1005				per diem		1065				per diem						other	DRG	
ROOM AND BOARD GERO PSYCH	124	RC	facility	inpatient				1400	1000	840	1209					other	DRG	1065				per diem		1065				per diem		1058				per diem		1058				per diem		1058				per diem		1058				per diem		974				per diem		1091				per diem		974				per diem		1058				per diem		840				per diem						other	DRG	1152				per diem						other	DRG					other	DRG					other	DRG	974				per diem		974				per diem		1065				per diem						other	DRG	955				per diem		955				per diem		955				per diem						other	DRG	995				per diem		882				per diem						other	DRG	1202				per diem		1209				per diem		1079				per diem		955				per diem		1079				per diem		955				per diem						other	DRG	1065				per diem						other	DRG	1005				per diem		1065				per diem						other	DRG	
PSYCH EVAL - NO MEDS	90791	RC	facility	inpatient				310		154	179					  		179				fee schedule		179				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		154				fee schedule						  						  						  						  						  						  						  		154				fee schedule		154				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
PSYCH EVAL - WITH MEDS	90792	RC	facility	inpatient				310		176	201					  		201				fee schedule		201				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		176				fee schedule						  						  						  						  						  						  						  		176				fee schedule		176				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
SUBSEQUENT CARE - HIGH COMPLEXITY	99233	RC	facility	inpatient				175		122	136					  		136				fee schedule		136				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		122				fee schedule						  						  						  						  						  						  						  		122				fee schedule		122				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
SUBSEQUENT CARE - MODERATE COMPLEXITY	99232	RC	facility	inpatient				120		81	95					  		95				fee schedule		95				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		81				fee schedule						  						  						  						  						  						  						  		81				fee schedule		81				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
SUBSEQUENT CARE - LOW COMPLEXITY	99231	RC	facility	inpatient				120		51	51					  		51				fee schedule		51				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		51				fee schedule						  						  						  						  						  						  						  		51				fee schedule		51				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
DISCHARGE - LESS THANK 30 MINUTES	99238	RC	facility	inpatient				160		83	96					  		96				fee schedule		96				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		83				fee schedule						  						  						  						  						  						  						  		83				fee schedule		83				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  						  						  						  		
DISCHARGE -MORE THAN30 MINUTES	99239	RC	facility	inpatient				160		118	141					  		141				fee schedule		141				fee schedule						  						  						  						  						  						  						  						  						  						  						  						  		118				fee schedule						  						  						  						  						  						  						  		118				fee schedule		118				fee schedule