hospital_name last_updated_on version hospital_location hospital_address license_number|AZ "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." "Mesa Development Sub, LLC" 12/31/2024 2.0.0 "Mesa, Arizon" 3322 South Ellsworth Road 1013789668 | AZ TRUE description code |1 code|1|type billing_class setting drug_unit_of_measurement drug_type_of_measurement standard_charge | gross standard_charge|discounted_cash modifiers standard_charge|min standard_charge | max standard_charge|[payer_AARP MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_AARP MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_AARP MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_AARP MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_AARP MEDICARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_AARP MEDICARE ADVANTAGE ]|[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 BANNER ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA BANNER ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_AETNA BANNER ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_AETNA BANNER ]|[plan_ HMO/PPO] standard_charge|[payer_AETNA BANNER ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_AETNA BANNER ]|[plan_ HMO/PPO] standard_charge|[payer_AETNA LIFE AND CAUSAULTY ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_AETNA LIFE AND CAUSAULTY ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_AETNA LIFE AND CAUSAULTY ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_AETNA LIFE AND CAUSAULTY ]|[plan_ HMO/PPO] standard_charge|[payer_AETNA LIFE AND 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]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_BEACON VO COMM ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_BEACON VO COMM ]|[plan_ HMO/PPO] standard_charge|[payer_BEACON VO COMM ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_BEACON VO COMM ]|[plan_ HMO/PPO] standard_charge|[payer_BEACON/TOTAL HEALTH CARE ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_BEACON/TOTAL HEALTH CARE ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_BEACON/TOTAL HEALTH CARE ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_BEACON/TOTAL HEALTH CARE ]|[plan_ HMO/PPO] standard_charge|[payer_BEACON/TOTAL HEALTH CARE ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_BEACON/TOTAL HEALTH CARE ]|[plan_ HMO/PPO] standard_charge|[payer_BENESYS ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_BENESYS ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_BENESYS ]|[plan_ HMO/PPO]|negotiated_algorithm 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]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_COFINITY ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_COFINITY ]|[plan_ HMO/PPO] standard_charge|[payer_COFINITY ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_COFINITY ]|[plan_ HMO/PPO] standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_COMPSYCH ]|[plan_ HMO/PPO] standard_charge|[payer_COMPSYCH ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_COMPSYCH ]|[plan_ HMO/PPO] standard_charge|[payer_CYPRESS BENEFITS ADMIN ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_CYPRESS BENEFITS ADMIN ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_CYPRESS BENEFITS ADMIN ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_CYPRESS BENEFITS ADMIN ]|[plan_ COMMERCIAL] 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standard_charge|[payer_HAP ADOL ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_HAP ADOL ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HAP ADOL ]|[plan_ HMO/PPO] standard_charge|[payer_HAP ADOL ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_HAP ADOL ]|[plan_ HMO/PPO] standard_charge|[payer_HAP ADULT ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HAP ADULT ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_HAP ADULT ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HAP ADULT ]|[plan_ HMO/PPO] standard_charge|[payer_HAP ADULT ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_HAP ADULT ]|[plan_ HMO/PPO] standard_charge|[payer_HAP DD ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HAP DD ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_HAP DD ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HAP DD ]|[plan_ HMO/PPO] standard_charge|[payer_HAP DD ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_HAP DD ]|[plan_ HMO/PPO] standard_charge|[payer_HAP SENIOR PLUS MNGD MCR ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HAP SENIOR PLUS MNGD MCR ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_HAP SENIOR PLUS MNGD MCR ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_HAP SENIOR PLUS MNGD MCR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HAP SENIOR PLUS MNGD MCR ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_HAP SENIOR PLUS MNGD MCR ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HEALTH CHOICE ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HEALTH CHOICE ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_HEALTH CHOICE ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_HEALTH CHOICE ]|[plan_ COMMERCIAL] standard_charge|[payer_HEALTH CHOICE ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_HEALTH CHOICE ]|[plan_ COMMERCIAL] standard_charge|[payer_HEALTH PLUS ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HEALTH PLUS ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_HEALTH PLUS ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HEALTH PLUS ]|[plan_ HMO/PPO] standard_charge|[payer_HEALTH PLUS ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_HEALTH PLUS ]|[plan_ HMO/PPO] standard_charge|[payer_HEALTHCHOICE AZ ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_HEALTHCHOICE AZ ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_HEALTHCHOICE AZ ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_HEALTHCHOICE AZ ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_HEALTHCHOICE AZ ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_HEALTHCHOICE AZ ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_HFN INC ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_HFN INC ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_HFN INC ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_HFN INC ]|[plan_ COMMERCIAL] standard_charge|[payer_HFN INC ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_HFN INC ]|[plan_ COMMERCIAL] standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HUMANA ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_HUMANA ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_HUMANA GOLD ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_HUMANA LIFESYNCH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_HUMANA LIFESYNCH ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_HUMANA LIFESYNCH ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_HUMANA LIFESYNCH ]|[plan_ HMO/PPO] standard_charge|[payer_HUMANA LIFESYNCH ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_HUMANA LIFESYNCH ]|[plan_ HMO/PPO] standard_charge|[payer_MCLAREN HEALTH PLAN ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MCLAREN HEALTH PLAN ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_MCLAREN HEALTH PLAN ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MCLAREN HEALTH PLAN ]|[plan_ HMO/PPO] standard_charge|[payer_MCLAREN HEALTH PLAN ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_MCLAREN HEALTH PLAN ]|[plan_ HMO/PPO] standard_charge|[payer_MEDICAID (OUT-OF-STATE) ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_dollar standard_charge|[payer_MEDICAID (OUT-OF-STATE) ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_percentage standard_charge|[payer_MEDICAID (OUT-OF-STATE) ]|[plan_ MEDICAID: OUT OF STATE]|negotiated_algorithm estimated_amount|[payer_MEDICAID (OUT-OF-STATE) ]|[plan_ MEDICAID: OUT OF STATE] standard_charge|[payer_MEDICAID (OUT-OF-STATE) ]|[plan_ MEDICAID: OUT OF STATE]|methodology additional_payer_notes|[payer_MEDICAID (OUT-OF-STATE) ]|[plan_ MEDICAID: OUT OF STATE] 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_MERCY CARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MERCY CARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MERCY CARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MERCY CARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MERCY CARE ADVANTAGE ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_MERCY CARE ADVANTAGE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MERCY CARE DCS CHP ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MERCY CARE DCS CHP ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MERCY CARE DCS CHP ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MERCY CARE DCS CHP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MERCY CARE DCS CHP ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_MERCY CARE DCS CHP ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MERCY CARE PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MERCY CARE PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MERCY CARE PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MERCY CARE PLAN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MERCY CARE PLAN ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_MERCY CARE PLAN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MERCY CARE RHBA ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MERCY CARE RHBA ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MERCY CARE RHBA ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MERCY CARE RHBA ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MERCY CARE RHBA ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_MERCY CARE RHBA ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MERITAIN HEALTH AETNA ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MERITAIN HEALTH AETNA ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_MERITAIN HEALTH AETNA ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_MERITAIN HEALTH AETNA ]|[plan_ COMMERCIAL] standard_charge|[payer_MERITAIN HEALTH AETNA ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_MERITAIN HEALTH AETNA ]|[plan_ COMMERCIAL] standard_charge|[payer_MHL MACOMB REGION 9 ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MHL MACOMB REGION 9 ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MHL MACOMB REGION 9 ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MHL MACOMB REGION 9 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MHL MACOMB REGION 9 ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_MHL MACOMB REGION 9 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MHL SW REGION 4 ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MHL SW REGION 4 ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MHL SW REGION 4 ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MHL SW REGION 4 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MHL SW REGION 4 ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_MHL SW REGION 4 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MHL WAYNE REGION 7 ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MHL WAYNE REGION 7 ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MHL WAYNE REGION 7 ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MHL WAYNE REGION 7 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MHL WAYNE REGION 7 ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_MHL WAYNE REGION 7 ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] standard_charge|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_MISC COMMERCIAL ]|[plan_ COMMERCIAL] standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO] standard_charge|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_MISC HMO/PPO ]|[plan_ HMO/PPO] standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_MISC MGD MCARE ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_MISC MGD MCD ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA COMPLETE CARE ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_MOLINA COMPLETE CARE ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_MOLINA COMPLETE CARE ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_MOLINA COMPLETE CARE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_MOLINA COMPLETE CARE ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_MOLINA COMPLETE CARE ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_OXFORD HEALTH ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_OXFORD HEALTH ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_OXFORD HEALTH ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_OXFORD HEALTH ]|[plan_ COMMERCIAL] standard_charge|[payer_OXFORD HEALTH ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_OXFORD HEALTH ]|[plan_ COMMERCIAL] standard_charge|[payer_PHYSICIAN HEALTH PLAN ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_PHYSICIAN HEALTH PLAN ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_PHYSICIAN HEALTH PLAN ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_PHYSICIAN HEALTH PLAN ]|[plan_ COMMERCIAL] standard_charge|[payer_PHYSICIAN HEALTH PLAN ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_PHYSICIAN HEALTH PLAN ]|[plan_ COMMERCIAL] standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_PRIORITY HEALTH ]|[plan_ HMO/PPO] standard_charge|[payer_PRIVATE PAY-NX ]|[plan_ PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_PRIVATE PAY-NX ]|[plan_ PENDING MEDICAID]|negotiated_percentage standard_charge|[payer_PRIVATE PAY-NX ]|[plan_ PENDING MEDICAID]|negotiated_algorithm estimated_amount|[payer_PRIVATE PAY-NX ]|[plan_ PENDING MEDICAID] standard_charge|[payer_PRIVATE PAY-NX ]|[plan_ PENDING MEDICAID]|methodology additional_payer_notes|[payer_PRIVATE PAY-NX ]|[plan_ PENDING MEDICAID] 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_SUREST ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_SUREST ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_SUREST ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_SUREST ]|[plan_ HMO/PPO] standard_charge|[payer_SUREST ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_SUREST ]|[plan_ HMO/PPO] standard_charge|[payer_TRICARE ]|[plan_ TRICARE]|negotiated_dollar standard_charge|[payer_TRICARE ]|[plan_ TRICARE]|negotiated_percentage standard_charge|[payer_TRICARE ]|[plan_ TRICARE]|negotiated_algorithm estimated_amount|[payer_TRICARE ]|[plan_ TRICARE] standard_charge|[payer_TRICARE ]|[plan_ TRICARE]|methodology additional_payer_notes|[payer_TRICARE ]|[plan_ TRICARE] standard_charge|[payer_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_TRIWEST ALLIANCE VA CCN ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_TRIWEST ALLIANCE VA CCN ]|[plan_ VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_TRIWEST ALLIANCE VA CCN ]|[plan_ VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_TRIWEST ALLIANCE VA CCN ]|[plan_ VETERANS ADMIN] standard_charge|[payer_TRIWEST ALLIANCE VA CCN ]|[plan_ VETERANS ADMIN]|methodology additional_payer_notes|[payer_TRIWEST ALLIANCE VA CCN ]|[plan_ VETERANS ADMIN] 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 KIDS/GERO ]|[plan_ HMO/PPO]|negotiated_dollar standard_charge|[payer_UBH KIDS/GERO ]|[plan_ HMO/PPO]|negotiated_percentage standard_charge|[payer_UBH KIDS/GERO ]|[plan_ HMO/PPO]|negotiated_algorithm estimated_amount|[payer_UBH KIDS/GERO ]|[plan_ HMO/PPO] standard_charge|[payer_UBH KIDS/GERO ]|[plan_ HMO/PPO]|methodology additional_payer_notes|[payer_UBH KIDS/GERO ]|[plan_ HMO/PPO] standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_UHC COMMUNITY PLAN ]|[plan_ MANAGED MEDICAID] 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_UMR ]|[plan_ COMMERCIAL]|negotiated_dollar standard_charge|[payer_UMR ]|[plan_ COMMERCIAL]|negotiated_percentage standard_charge|[payer_UMR ]|[plan_ COMMERCIAL]|negotiated_algorithm estimated_amount|[payer_UMR ]|[plan_ COMMERCIAL] standard_charge|[payer_UMR ]|[plan_ COMMERCIAL]|methodology additional_payer_notes|[payer_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 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_VA OFFICE COMMUNITY CARE ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_VA OFFICE COMMUNITY CARE ]|[plan_ VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_VA OFFICE COMMUNITY CARE ]|[plan_ VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_VA OFFICE COMMUNITY CARE ]|[plan_ VETERANS ADMIN] standard_charge|[payer_VA OFFICE COMMUNITY CARE ]|[plan_ VETERANS ADMIN]|methodology additional_payer_notes|[payer_VA OFFICE COMMUNITY CARE ]|[plan_ VETERANS ADMIN] standard_charge|[payer_WAYNE COUNTY MCD UNASSIGN ]|[plan_ MANAGED MEDICAID]|negotiated_dollar standard_charge|[payer_WAYNE COUNTY MCD UNASSIGN ]|[plan_ MANAGED MEDICAID]|negotiated_percentage standard_charge|[payer_WAYNE COUNTY MCD UNASSIGN ]|[plan_ MANAGED MEDICAID]|negotiated_algorithm estimated_amount|[payer_WAYNE COUNTY MCD UNASSIGN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_WAYNE COUNTY MCD UNASSIGN ]|[plan_ MANAGED MEDICAID]|methodology additional_payer_notes|[payer_WAYNE COUNTY MCD UNASSIGN ]|[plan_ MANAGED MEDICAID] standard_charge|[payer_WAYNE UNASSIGN PENDING ]|[plan_ PENDING MEDICAID]|negotiated_dollar standard_charge|[payer_WAYNE UNASSIGN PENDING ]|[plan_ PENDING MEDICAID]|negotiated_percentage standard_charge|[payer_WAYNE UNASSIGN PENDING ]|[plan_ PENDING MEDICAID]|negotiated_algorithm estimated_amount|[payer_WAYNE UNASSIGN PENDING ]|[plan_ PENDING MEDICAID] standard_charge|[payer_WAYNE UNASSIGN PENDING ]|[plan_ PENDING MEDICAID]|methodology additional_payer_notes|[payer_WAYNE UNASSIGN PENDING ]|[plan_ PENDING MEDICAID] standard_charge|[payer_WELLCARE BY ALLWELL ]|[plan_ MANAGED MEDICARE]|negotiated_dollar standard_charge|[payer_WELLCARE BY ALLWELL ]|[plan_ MANAGED MEDICARE]|negotiated_percentage standard_charge|[payer_WELLCARE BY ALLWELL ]|[plan_ MANAGED MEDICARE]|negotiated_algorithm estimated_amount|[payer_WELLCARE BY ALLWELL ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_WELLCARE BY ALLWELL ]|[plan_ MANAGED MEDICARE]|methodology additional_payer_notes|[payer_WELLCARE BY ALLWELL ]|[plan_ MANAGED MEDICARE] standard_charge|[payer_WPS VA ]|[plan_ VETERANS ADMIN]|negotiated_dollar standard_charge|[payer_WPS VA ]|[plan_ VETERANS ADMIN]|negotiated_percentage standard_charge|[payer_WPS VA ]|[plan_ VETERANS ADMIN]|negotiated_algorithm estimated_amount|[payer_WPS VA ]|[plan_ VETERANS ADMIN] standard_charge|[payer_WPS VA ]|[plan_ VETERANS ADMIN]|methodology additional_payer_notes|[payer_WPS VA ]|[plan_ VETERANS ADMIN] additional_generic_notes R&B PSYCH ADULT 124 RC facility Inpatient 2700 1100 816 2700 2700 per diem 2700 per diem 2700 per diem 2700 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem R&B PSYCH GERI 124 RC facility Inpatient 2700 1100 816 2700 2700 per diem 2700 per diem 2700 per diem 2700 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem R&B PSYCH YOUTH 124 RC facility Inpatient 2700 1100 816 2700 2700 per diem 2700 per diem 2700 per diem 2700 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 816 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem R&B DETOX ADULT 126 RC facility Inpatient 2700 1100 739 2700 2700 per diem 2700 per diem 2700 per diem 2700 per diem 739 per diem 739 per diem 739 per diem 739 per diem 739 per diem 739 per diem 739 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem R&B DETOX YOUTH 126 RC facility Inpatient 2700 1100 739 2700 2700 per diem 2700 per diem 2700 per diem 2700 per diem 739 per diem 739 per diem 739 per diem 739 per diem 739 per diem 739 per diem 739 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 1100 per diem 1100 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem 2700 per diem IOP PSYCH ADOL 905 RC facility Outpatient 800 300 300 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 300 per diem 300 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP PSYCH ADOL TELE 905 RC facility Outpatient 1400 500 300 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 300 per diem 300 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP PSYCH ADULT 905 RC facility Outpatient 1400 500 300 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 300 per diem 300 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP PSYCH ADULT TELE 905 RC facility Outpatient 1400 500 300 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 300 per diem 300 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP PSYCH GERI 905 RC facility Outpatient 800 300 300 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 300 per diem 300 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP PSYCH GERI TELE 905 RC facility Outpatient 1400 500 300 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 300 per diem 300 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP CD ADOL 906 RC facility Outpatient 800 300 800 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP CD ADOL TELE 906 RC facility Outpatient 1400 500 800 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP CD ADULT 906 RC facility Outpatient 800 300 800 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP CD ADULT TELE 906 RC facility Outpatient 1400 500 800 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP CD GERI 906 RC facility Outpatient 800 300 800 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem IOP CD GERI TELE 906 RC facility Outpatient 1400 500 800 800 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem 800 per diem